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AUTHORIZATION FORM <br /> LANDLORDLETTER <br /> To Whom It May Concern: <br /> I� � Property owner/Landlord of the propert�located at <br /> �� � .do hereby authonze <br /> —�a����—CS 1�..�.� ' and/or its agents to apply for and retain sign pe.nnits and to remove, <br /> modify and/or erect signs,and�Qbta.u�building and electrical pernvts as required by state and local laws. I further <br /> authorize TQ,Iy1.,�'J 4 C�lQ)').�Qj to act as agent on my behalf;and sign any <br /> documents necessary for the procurement of vanances and pertnits related to this project. I authonze said <br /> contractor(ar authorized agent) to sign and notatize vanance and pern�ut applicanon(s) as owner/agent.All work <br /> will meet or exceed code requirements. <br /> , <br /> f <br /> / � <br /> � ` � t�-/10-11.� <br /> rs ture Date <br /> Tracy Heisler 813-382-8501 <br /> Chvners Prmted Name Phone Number <br /> 11501 Northlake Dnve_Cmcuinat�OH 45249 <br /> Chvners Address <br /> Notarv: <br /> Sworn a acknowledged before me tlus�Day o 2p12 <br /> NOTAR PUBLIC,STAT'E OF � <br /> Comimssion Expires: �O�v�,• � ,�1� <br /> AUILLERMO BRACAMONTES <br /> ��� Notary Pubiic,State of Florida <br /> Commisstoni EE 58752 <br /> IJIy oomm.expires January 26�2015 <br /> I I501 NORTHLAKE DRIVE � CWGNNATI, OHIO 45249 � �513) 554-I 110 �800) 875-6565 FAX (513) 554-1009 I <br /> WWW PHI�LIPSEDISON COM � <br />