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A_ UTHO.RIZED_AGENT <br /> AFFIDAVIT <br /> I Joseph Mignoli hereby grant authorization to Ashley Mignoli <br /> (Contractor) (Authorized Agent) <br /> to act in my behalf with the City of Zephryhills Building Division while conducting activities related <br /> to obtaining permits. These activities specifically include signing all documents requiring signature <br /> of°contractor". <br /> Ashley Mignoli is to be considered an agent of my business and <br /> (Authorized Agent) <br /> therefore the signature of said agent is binding and causes me to assume all responsibilities <br /> connected to or associated with the signature as they may relate to my contracting business. <br /> I Joseph Mignoli relieve the City of Zephryhills of, <br /> (Contractor) <br /> and agree to hold the City of Zephyhills Building Division harmless from, any and all responsibility, <br /> claims or other actions arising from or related'to the Division's acceptance of the above agent's <br /> signature for permit-related activities. I further understand that it is my sole responsibility to grant <br /> and terminate any such authorization and to ensure that the Division receives timely notice of any <br /> such 77rmination <br /> 4 <br /> 14% '1/ Lr��.- <br /> Signature o Contra for Signature of Agent <br /> State Certification or Registration Number <br /> N(h <br /> County Certification Number(if applicable) <br /> "PLEASE NOTE: BOTH SIGNATURES MUST BE NOTARIZED" <br /> Notary for Contractor's Signature: Notary for Agent's Signature: <br /> State of F 1 County of hki A rw%a o State of Pi County of l t t r n a^J- <br /> The foregoing was acknowledged before me this ywd The foregoing was acknowledged before me this ZAJ <br /> dayof Jv.r4 voyo , 3y1 by day of jL*0%-� , .. by I% sklc.j m;Onoli <br /> k�tph nn:61owlc who is personals known who is personally known to me,or <br /> lryme,or who produced as who produced as <br /> identification. Identification. , <br /> Notary PiSlic Signature Notary ublic Signature <br /> Print,Type,or Stamp Name of Notary Print,Type,or Stamp Name of Notary <br /> FF <br /> !!ye JOSEPH PCHELKA �i3!+►ghc: JOSEPH PCHELKA <br /> _ MY COMMISSION#GG 219781 <br /> *: MY COMMISSION#GG 219781 <br /> EXPIRES:May 20,2022 =�� a� EXPIRES:May 20,2022 <br /> Bonded Thru Notary Public Underwriters -OR F�°P' Bonded Thru Notary Public Undervrrtlers <br />