Laserfiche WebLink
<br />03-19-2008 13:22 POSITIVE PLUMBING 3525971173 <br /> <br />PAGE5 <br /> <br />Positive Plumbing <br />9225 Sikes Cowpen RD <br />8roobvjUe FL 34601 <br />Otlice 352-585-0899 <br />Fax 352-597-1173 <br /> <br />AUTHORIZED AGENT AFFIDAVIT <br /> <br />I, Jeffrey S lJ1'8.V hereby grant authorization to _ Mandi L Harmon <br />(Contractor) (AUthOri7.ed Agent) <br />to act in my bebalfwith the City of 7.ephyrhill!; while conducting activities related to obtaining <br />permits These activities specifically include signing an documents requiring signature of <br />"contractor" _ <br /> <br />- Mandi L Harmon is to be considered an ag,,-nt of my business and therefore the <br />(Authori7.ed Agent) <br />signature of said agent is binding and causes me to &.lOSWDe all responsibiJitieR connected to or <br />associated with the signature as they may relate to my contracting business. <br /> <br />1, Jeffiey S Gnlv relieve the City of ZephyrhiJIs harmless from. and all <br />responsibility, claims or other actions arising from or related to the department's acceplance of <br />the above agents signature for permit-related activities. 1 further understand that it is my sole <br />responsibility to grant and terminate any such authorization and to ensure that the department <br />receives timely notice of any such grant or termination. <br /> <br />#~"7 <br /> <br />CFC056942 <br />State Certification Number <br /> <br />'. <br /> <br /> <br />"PLEASE NOTE: BOTH SIGNAURES MUST BE NOTARIZED"'''' <br /> <br />Notary for Conlractor's Signature <br />Stale of}1al:l'county OF \i..c~'"'~ <br /> <br />Notary for Agent's Signature <br />-~ <br />Stale of~. ~OUJ1ty OF ~~ <br /> <br />The: foregoing was acknowledged before me this <br />~dayof~t^ ~~,by <br />~~~ s. G,l~. , <br />Who is pen ally known to ile. or who <br />prodoooo u <br />identification. <br /> <br />~-S, \;~~___ <br /> <br />Notary Public Signature <br />NOTARY PUBUC-St<\TE OF FLORIDA <br />~.It:rurlft., L. !h!.tuodiC! <br />Print, 'fy . 1827 <br />plrGII. ~t!~200~ <br />Dcmcled ~ AtIilJ\11t JMUUI'll \':.Ii-,~. <br /> <br />The foregoing was acknowledged before me this <br />,^~yof~~.a.~~ "by <br />~AA.I..,._~( ~"'^ <br />Who is personallY known to me, or who <br />produced , q'. as <br />identification. <br /> <br />~.st.\J~ <br /> <br />Notary Public Signature <br /> <br />NOTARY PL'BL1C-ST.~TE OF FLORIDA <br />~lllllanowia <br />Print, . . . 27 <br />Exp 1:,: 1Jy:;.~~ <br />l\Onded 11uu AllanUc llulu1in& ce., Ll!I!: <br />