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AUTHORIZATION FORM <br /> LANDLORD LETTER <br /> To Whom It May Concern: <br /> I, �'Q -Q.� `e, Property owner/Landlord of the propem�located at <br /> .do hereby autho=ize <br /> ► t Li {� I►7 and/or its agents to apply for and retain si�n permits and to remove, <br /> moei�fy and or erect s s,and o tam b ding and electacal pemuts as requ�ed by state and local laws. I further <br /> authonze � y -f I to act as agent on my behalf,and sign any <br /> documents necess for t e procurement of riances and permits related to tlus project.I authorize said <br /> contractor(or authorized agent) to sign and notanze vanance and pemut apphcation(s) as owner/agent.All work <br /> will meet or exceed code reqwrements. <br /> ; f � <br /> .,, <br /> / <br /> '�� �a �2 D I�� <br /> Chvne�s S ature Date <br /> . <br /> ►'a c.�. -e ( -2r'' ��3 - 3 �a - S��d,� <br /> Chvners P ted Name Phone Number <br /> . <br /> 115� � 1�1or�-4, �����ie- y�v4 aCcy► c�v���d ()�-f' �SZ`� �l <br /> J Owners Address <br /> No_ r �� � <br /> J <br /> Sworn and acknowledged before me tlu� llay of �,201��J <br /> NOTARY P LIC,STr�TE OF I CFL <br /> Commission Expires: �. C��'� �`� <br /> Q�µ,L,ERMO BRACAMONTES <br /> ��� �ry p�bNc,Ste�of Florida <br /> Commisslorq�EE 58752 <br /> �,�y comm.e�ires JeuMm7 26�201 S <br /> I I501 NORTHLAKE DRIVE I GNCINNATI,OHIO 45249 ; (5!3) 554-I I10 (800) 875-6585 PAX (513) 554-1009 I ^ <br /> r \ <br /> WWW PHILLIPSEDISOfJ COM ��� <br />