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<br />~~'OO/La~~ ~~;~( <br /> <br />~l':s':l~.'::l~':' <br /> <br />H..A/'ll ''';.1 If 1:S.:.uJ'.;ul.i"::' <br /> <br />t-'~t:. '.3.1. <br /> <br />FRa~ : ~)lt WLL~r ARCHITECT <br />...~_I <br /> <br />PHCJE NO. 863 &46 9136 <br /> <br />Dl!e. 06 2l?01 0!5 : 4eflM p;z <br /> <br />12106101 <br /> <br />To wbOlD it may c:oD(.erIl. <br /> <br />[Colemau Davis avwrlzt1he W.S. Bmcook;Corporation to apply fortb.e <br />n~aary Ii. ~ 10 ere.et . n.., -len no ~ exterior of Dl) bui1~ <br />and inl1lll1 tOe i.nwlor slpaaa at my property located at: <br /> <br />Badcock Home 'f:umilhl"1p Center <br />"00 ". S-. : <br />ZqbytblilJ, PI. 33"41..399P <br /> <br />fe~ <br /> <br />Signatw'e: <br /> <br />Date: <br /> <br />~"ltt#l,...~ Carmen A. BrittOl~ <br />'-Commission # CC 973026 <br />~S Exp!res Oct. 5,2004 <br />~.. ~~ .Bonded Thru. <br />f "II" \ \ Atlantic Bonding C:i/fc <br /> <br />0-( ~ --- 4, (;" ((IT--) <br /> <br />STATE OF FLORIDA <br />COUNTY .OF POLK <br /> <br />Sworn to (or affl~~d) and ,ubscrlbed before me this <br />~day of J,A: ~ 0 iY'\12~ . 20.a.L-. <br />. by 6"'fY\.Q,.., C. P~v.::> <br /> <br />~1~t'~tJ. ~f, ''H-r-, <br /> <br />CARMEN A. BRITTON <br />Personally Known..!::::::. OR Produced Identification <br />Type of 1.0. <br /> <br /> <br />Icb -- () f - () / <br />