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Advantage Building Concepts,Inc <br /> 3214 Timberline Road <br /> Winter Haven, Florida 33880 <br /> 863-521-0527 <br /> CBC1257674 <br /> CONTRACTOR AUTHORIZATION FORM <br /> CONTRACTOR ID# _ ; ' P ('�t,7cx�k�� <br /> STATE CERTIFIED LICENSE # �(' r`�5 7(�7 �f- <br /> QUALIFERS NAME � ° - � <br /> BUSINESS NAME � ^ � d►i�� � �' s Jrr�. <br /> I authorize the following individuals to sign for and obtain permits. <br /> **THIS AUTHORIZATION SUPERSEDES ALL PREVIOUS SUBMITTED <br /> AUTHORIZATIONS** <br /> � c� (, ,, <br /> , <br /> , <br /> Signature of qualifier• <br /> State of�County of ����� Sworn to and subscribed before this day <br /> ������f � <br /> ��� �� <br /> � � <br /> •`�""'^'b.,- ANNA A JAfiVIS <br /> `,, �;My . ' ��, <br /> '•.+. P. <br /> �.;���,d;. Commi�sion�M EE Q7�097 <br /> �„��,�.,. <br /> ,.� <br />