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�'ence Outlet of Tampa Inc. <br /> 201 S. Falkenburg Road <br /> Tampa, FL 33619 <br /> Office (813) 651-3623 <br /> Fax (813) 651-3655 <br /> AUTHORIZED AGENT FORM <br /> I,Jeffrev Tinnon OF Fence Outlet of Tampa Inc. HAVING PERSONALLY APPEARED FOR <br /> INDENTIFICATION,DO HEREBY AUTHORZIE THE FOLLOWING TO ACT AS MY AGENT(S)IN SUBMITTING <br /> PERMINT APPLICATIONS IN THE AREA OF CITY OF ZEPHERHILLS <br /> (1) Ana King <br /> I UNDERSTAND THAT I AM THE LICENSED QUALIFIER RESPONSIBLE FOR THE APPLICATION AS <br /> SUBMITTED BY MY AGENT(S),AS REFERENCED ABOVE. I FURTHER ACKNOWLEDGE THAT THIS <br /> ORIGINAL AUTHORIZATION FORM IS IN MY LICENSE OR QUALIFICATION FILE FOR LEGAL REFERENCE <br /> PURPOS . <br /> X X l _'�1,�� <br /> Contr c r's Si ture ` Date Registration/Certification/License Number <br /> (1) <br /> Agen s Signa re <br /> NOTICE: THE LICENSED CONTRACTOR'S SIGNATURE IS TO BE NOTARIZED <br /> State Of: FLORIDA <br /> County Of: HILLSBOROUGH <br /> The foregoing insriument was acknowledged before me this_17th day of January_,2013, <br /> By _ �e"�� �j Nf�On ,who is ersonall know to me <br /> P y ()or has provided <br /> the following identification <br /> ��— <br /> 1 'a , <br /> Notary's Signature <br /> "„,,. nw►�e��r <br /> Commission Expires; 01-15-2015 ��= MYCOMMISSION#EE056141 <br /> �� EXPIRE$:Januery 18,2015 <br /> `�'•... gondee TIw NofaY P�bik underw�iters <br />