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<br />CITY OF ZEPHYRHILLS <br /> <br />Permit Authorization Form <br /> <br />I, Michael R. Willis. Sr. (Contractor) . Contractor License No. 48254100012004 , <br />hereby authorize the following to act as my agent(s) in obtaining permits in the City Of <br />Zephyrhills, Florida. <br /> <br />Name Of Agent Driver's License No. <br />Sean Hill H400-795-68-042-0 <br />Tim Humbert H516-80 1-56- 310-0 <br /> <br />This authorization is to be in effect March 11,2008 until March 10,2009. <br /> <br />~/~ <br /> <br />f Contractor's Signature <br /> <br />STATE OF F)Dyida- <br />COUNTY OF PI) I k <br />Sworn To (or affirmed) and subscribed before me this <br />I I +-~ . Day Of '-Y'Y\.Q y r f...... - <br /> <br />. 20~ by Michael R. Willis. Sr. <br /> <br />NOTARY PUBLIC <br /> <br />~/ '--f7. Cu~--b4 <br /> <br />Signature Of Notary) <br /> <br />I .a:......:.~ BRIOOETN. CURns <br />~: :~ MY COMMISSION # DD 634084 <br />~~. ...o$.'Jl EXPIRES: March 23, 2011 <br />'''1'Rr..Il<-;''' Bonded Thill N01aJy Public Underwrll8lll <br /> <br />(Stamped Name Of Notary) <br />My Commission Expires: YrlCVld ,';) 31 dO II <br /> <br />Personally Known:'/.. OR <br /> <br />Produced Identification: <br /> <br />(Type Of Identification) <br />