Laserfiche WebLink
. <br /> ' PUWER U ATT4RNEY <br /> Date: � 1 d��� <br /> 1 hereby name end appoint ��� ��i� w, L�''�`� • <br /> of ��--�``�' C��'�•��' � c.� to be my lawful aftomey-in-fact to <br /> act for me, and apply ta the Division of B itding Safety far a ���L��� perrrt�t <br /> . for work to t�e pertormed at a Iocation descr bed as: <br /> ' Parcel !D#:Section Township Rang Subdivision Slock �.�� Lot t�7�o <br /> (45 t7igit Parcel Number) <br /> Subdivision Name: <br /> Owner of Property: �d��"" ���"t' �- �.�-�- <br /> Project Address: �02 j� �� <br /> City:`�T��7�^f?,-�� Zip de: �,�.�f Z -- ' <br /> and to sign my�name and do a(I things nece sary to this appointment. <br /> C�Y,s ��>��,,. - �� s �r� �r,� _ �'�-��z�:�3 I <br /> (Conirac#or Name)( e or Print} (Contractor's License Number} <br /> , <br /> (Contractor Si ture} <br /> The foregoing instrument was acknowledged bef re me this��ay af�_ <br /> of 20�,by <br /> wha is personaliy known fa me or who produced <br /> as iclentification and who did not take an oath. <br /> Seal <br /> Notary lic riitt name <br /> N ublic (Signature) :o;:aY p"",•,,� NICOLE POWER �` ' "� <br /> =r; := Netary Pubflc-Stntl al Flal�a <br /> Rev 03t13113 :,.Y 'T=My Comm.ExptrEs Dec 12.2017 <br /> ••,% H,��;A`� Commission M fF 07631� <br />