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Nov 08 10 01:04p BIG DADDY'S M.H. SET-LIP (863)875-0703 p.2 <br /> DADT.Ny'S M. frt. .5 ET-14P 5 ERVICZ, LLG. <br /> .21 AVENt.LE A F.AST <br /> ". 'MN 1V2.1-1AV N, FL 33880 <br /> ■ <br /> ; "Po' ; r - <br /> Phone (863) 287-42 12 <br /> Fax (363) 875-0703 <br /> OWNE1t1A POE PEFERSON ,- , , / <br /> STATE ucEnsE v-steesessr- J.tt - //l.)...5.2 ( 3 1 <br /> SIGNATURE AUTHORITY FORM <br /> FOR THE PURPOSE OF OBTAINING BUR.DING PERMITS <br /> . . _ <br /> 01.c . p . 'Son <br /> 4e-ii e3 avictic_ nk [1 e_i- up Sevlil a. <br /> tout awe Awe) Wet bushing name hate) <br /> Do hereby designate the following indfreldual(s) as having the authority to sign and submit applications and - <br /> ra ts dor= for the purpose of obtaining building pennks under my license in <br /> i of , yr b Jiic county. I furtheracknowledge and accept , as a <br /> (pint sane otcomly here) <br /> licensed contractor, my ;immortal fity and liability for each project permitted under the authority designated <br /> on this form, and that my bilere to assume and fulfill said duty may be grounds fertile irritation of <br /> disciplinary action against My contractor's license. <br /> ---- mmuolunno.-- <br /> DESIGNATED SIGNERS: <br /> Cautractot's $Ignstune DATE <br /> . <br /> 1. =het h Subscribed andswom to berme me this ¥tL <br /> 2. 2___". p____. <br /> 3. <br /> 4. .......1..nr <br /> 5. Notary Mlle's Span <br /> '. SSI°' "3 . s ,' ' - — • ir 7 ' !.. ROSEN <br /> (e4.- -,ki,•f,,i,,, <br /> Es not ( ) Persona* Imam to me <br /> Identified by r10q4; 4 P)-vve 4 c- <br />