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<br />Bldg. Permit Application No.: <br />(To be Completed by Permit Representative) <br /> <br />AUTHORIZATION AFFIDAVIT <br /> <br />DATE: <br /> <br />/oill/cJ.. <br /> <br />TO WHOM IT MAY CONCERN: <br /> <br />L Daniel R. Schmitt <br /> <br />Wbh Schmitt INC. <br /> <br />License Number: <br /> <br />6410 & 2590 <br /> <br />, will be the Mechanical & Electrical <br /> <br />(Example: Electrical, Mechanical, <br /> <br />Plumbing, Roofing, Gas, Etc.) <br /> <br />contractor for this permit application. The job address <br /> <br /> <br />~ <br /> <br />of License Holder or Authorized Agent <br /> <br />'i!;\. Jacqueline A Barcia <br />~M':~My Commission CC80ff8f <br />"" ",," Expires March 8, 2003 <br /> <br />I HEREBY CERTIFY that the foregoing instrument was acknowledged before me this <br />of C? v\O ~ ,d..{)O'l , by Daniel R. Schmitt <br /> <br />personally lmown to 1J1C..Dr who has produced <br />Identification <br /> <br />I \t~ <br />,~ois <br />as <br /> <br />day <br /> <br /> <br />(l.~ <br /> <br />Print, Type, or Stamp Name of Notary <br /> <br />contauth.sop <br /> <br />Revised: 11/08/99 <br />