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<br />GROWTH MANAGEMENTIZONING DEPARTMENTIBUILDING DEPARTMENT <br />AGENT OF RECORD LEITER <br /> <br />TO THE GROWTH MANAGEMENT/ZONINGIBUlLDING DEPARTMENT: <br /> <br />I, /V1/hZ-K- k. cuAs.mtu--dL..- . (contractor/card holder name), License Number <br />~CXJU 1&.(75'" . of 1f'1&<;' w. ~y ~'/ Sf/tit ?feU, -anTi-Ji:-- 33(/1/ <br />(address), I hereby designate and appoint the below listed Agent(s) of Record for any necessary <br />permitting processes. <br /> <br />The Agent(s) of Record is vested with the authority to execute and file any and aU necessary sets of <br />plans, applications, or other required paperwork necessary in the permitting process. The Agent(s) of <br />Record has my authority to respond to any and all comments from staff <br /> <br />The authorized Agent(s) of Record is: <br /> <br />Lauralee G. Westine, Esquire and/or Edyne K. Bamberski <br />800 Tarpon Woods Blvd., Suite E-l <br />Palm Harbor, Florida 34685 <br />Phone (727) 773-2221 <br />Phone (813) 598-1545 <br />Fac. (727) 773-2616 <br />Email Laura lee@westinelawcQJll <br /> <br />DATED 'd/,Io& / i ~ <br />SIGNATURE OF CONTRACTOR: ~.4.. f} ~ <br />PRlNTED NAME OF CONTRACTOR: ;11~ A. Lv/Js;n/~ <br /> <br />ST ATE OF FLORlDA <br />COUNTY OF P'tfscc> <br /> <br />The foregoing instrument was acknowledged before me this I .st= day of 1i~ <br />by /Y/tfIvt:- )- tuH1(~ who is personally known to me or who has produced <br />as identification. <br /> <br />o-~:'I PCl<9~ Judy Fernandes <br />: <;: Commission # OD48989' <br />(SEAL) ~~()O# ~~~~.=~~~ ~~:~o~:: <br /> <br />,2006, <br /> <br />~ -:;;~ <br />Not ~liC <br />-;:;CGbY ~--S <br />Printed Name of Notary <br /> <br />My Commission Expires: II (1~/rrj <br />