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P.O.Box 3057 <br /> Riverview,FL 33568 <br /> Ph 813.415.2109 Fax 813.415.2109 <br /> Contractor Authorization Form <br /> jx* (ent Cawley . `A=First Choice Roofing <br /> Of <br /> (Print IECense hoMer name) (Print name of uskess as hated on license) <br /> do hereby designate the following individuals as having the anthoaity to agn and submit avpheaiions and <br /> related doemnents for the propose of o'bbinin building peanuts. <br /> DFMGNFr _SIGNERS;(P 1RTNT)_................_:. ._ _. .. _.. <br /> �. 'Jessica Peterso <br /> 2. Aiyssa Salyer, <br /> 3. <br /> 4. <br /> Designated signers may be required to provide identificatiomm at the request ofthe perni t office- <br /> ,,.. ....,_;.:...�... ......_._..... ..,.__... ..__.., . ._ <br /> Ie ,'CaWley <br /> License Holder Name—Print Licewe'Holder 5ignatme <br /> STATE OF FLORIDA COUNTY OF H RDEE <br /> Before rue,the undersigned,appeared C-�I-e.h <br /> On this the 7 day a N U\)�b—ei 1 <br /> (900 0 <br /> Who armed that he/she read and undeastood the foregoing and uh9tsig aed the <br /> same freely and voluntarily and who is pemoonally 1--mvm to me( V )or who <br /> prod as identification- <br /> ofNot ry hhr SEAL <br /> a� ��;;s,,� LISA ANNE PETERSON <br /> �ga;State of Florida-rotary Public <br /> • •= Commission #GG 220717 <br /> %;$ ,� My Commission Expires <br /> Sept6mber 15, 2022 <br /> www.ofirstchoiceroofing.com <br />