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<br />GROWTH MANAGEMENTIZONING DEPARTMENTIBUILDING DEPARTMENT <br />AGENT OF RECORD LEITER <br /> <br />TO THE GRowm MANAGEMENT/ZONING/BUILDING DEPARTMENT: <br /> <br />I, {n1Ui:YL- /Y'L ccc.:pcrC-- . (contractor/card holder name), License Number <br />u;.c.. o17~3 . oftt:'I{Pr;' (,0. G/fr..1:)Y BtrVD., 5Vt~ <5z:u '7/PYlFl-; fl.. 3'3/P11 <br />(address), I hereby designate and appoint the below listed Agent(s) of Record for any necessary <br />permitting precesses. <br /> <br />The Agent(s) of Record is vested with the authority to execute and file any and all 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 Lauralee@westinelaw.com <br /> <br />DATED <br /> <br />d. / ,/0 <br /> <br />~:f#~ <br /> <br />SIGNATURE OF CONTRACTOR: <br /> <br />PRINTED NAME OF CONTRACTOR: <br /> <br />fYl/L.-UIL rYI . Coc/p~lL <br /> <br />STATE OF FLORIDA <br />COUNTY OF ~o <br /> <br />The foregoing instrument was acknowledged before me this I ~ day of fiJ3rwd'tV( <br />by fY7/w{L-.;r). c.u;RL . who is personally known to me or who has produced <br />as identification <br /> <br />o#1r'\, Judy Fernandes <br />: C; Commission # 00489891 <br />(SEAL ~~ ~ Expires November 13, 2009 <br />OF IIanGtcI tll>y """'. Insurance. Inc aCJO.385.7019 <br /> <br />, 2006, <br /> <br />~~ ~~~ <br />N blic <br />d~Y fi:J?A/h4'S <br />Printed Name of Notary <br /> <br />My Commission Expires: III, 319 <br />