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��,ni hts ir ond'ti ' <br /> �' .� C onin <br /> License CAC18171 � <br /> 03 <br /> 8311 Carriage Pointe Dr Gibsonton FL 33534 <br /> Cell Phone 813-476-5725 <br /> 7/17/2013 <br /> Attention: Building Department <br /> I, N� / l bC� T Lt C .�r:S,S�h ,,f,� DO HEREBY AUTHORIZE <br /> (�i;�NT LICENSE HOLDER'S NAME) - <br /> �t vra�- �-r�c t3ri' � k Q—. M< <br /> (PRINT AGENT#1 NAME) — <br /> �� ,'cc.� � ,d� <br /> rnnn.T�r . � '�'♦ <br /> �r�iv 1 HV�1V 1 #"l NAIVl�"� —�" <br /> For the following time period(not to e�DD on��-*� r] /7 l,3 TO 7 /Ct / <br /> MM/DD/YYYy <br /> TO ACT AS MY AGENT IN SECURING PERMITS IN THE UNINCORPORATED AREA OF Zephyerhills COUNTY. <br /> I UNDERSTAND THAT I, AS THE LICENSED QUALIFIER, AM SOLELY RESPONSIBLE FOR ANY pERMIT <br /> SUBMITTED OR OBTAINED BY MY AGENT (S . <br /> / <br /> License Holder's Signature: Contractor's Lic.# G�C ��!r/'/a,3 <br /> Business Name: ��N/� -�s , K � ,(� � y? LL G <br /> Business Address (mailing): � 3/I ��ti-�i�� ��;K� �`, <br /> State of Florida COtJNTY of /-�i % �o ra� <br /> acknowled ed before me this /'7� day Of The foregoing instrument was <br /> by J i ,�-G,�¢-7" C �'.�s a�. ,Ti� , AD 20� <br /> (name of person acknowled in � <br /> g g) GLh G�' � ��� �e�ri p'�G <br /> ersonally Kno roduced ID: � .-�� �-�s o h ,�// �{�u w h -� `yr r <br /> (Type of ID and umber) � <br /> Notary Signature: �' <br /> ,�'" Naary P�a;�sace a F�ae <br /> • . Lisa Sisson <br /> Notary Name Printed: L i�l,� �'/SSo,�-� � � MY Cummisalon FF 033735 <br /> a ti Expires 07/07/2017 <br /> Per FS 117,107[12] "A Notary Public may not notarize a document in which the Notary's name appears as a <br /> party to the transaction." <br />