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� � v <br /> � � <br /> � <br /> • � � D ■ � • <br /> PERMIT AGENT AUT ORIZATION FORM <br /> ALL INFORMATION IS TO BE T PED OR LEGIBLY PRINTED <br /> I Anthon Gonzalez � CAC1816958 <br /> (Contractor's Name) NOT COMPANY NA E (Contractor's License No.) <br /> hereb authorize the followin to act as m a en (s) in obtainin permits in Ci of Ze h rhills <br /> Name of A `ent � � ` DriveYs License No. <br /> Berneice Vibbert V163-073-79-718-1 <br /> Robert Deese <br /> D200=762-64-171-0 <br />� Scott Richardson <br /> R263-785-77-229-0 <br /> Radford Richardson <br /> R263-736-90-326-0 <br /> Joseph Abel Martinez <br /> M635-010-90-103-0 <br /> Joshua Bello <br /> B400-430-91-168-0 <br /> Addison Hatcher ' H326-006-93-021-0 <br /> This form supercedes any previously submitted letter(s) of authorization. <br /> This form must contain only the people you want to pull permits in your name. To make changes to this <br /> form, you must submit a new form. This form will del te and replace any previous authorization form <br /> and the information contained thereon. <br /> STATE OF \ <br /> This authorization will remain in effect until � Ivr��G <br /> cancelled in writing by the undersigned 1 1 t,� <br /> license holder. <br /> COUNTY OF �`l`1S �/OC�(�� <br /> Sworn to(or�rmed)and subscribed before me this <br /> I l ,day of o �O'UC� r ,20 �L <br /> b le <br /> (PrintedlTyped ame of Licen e Hal er Making S atement) <br /> ense Holder's Signature Y P LIC <br /> `\������������+����/�� ( �gnature otary) <br /> \ D.Q �// <br /> ��`�Q,Q�P�Sgi•�:���,Q''.''�'� <br /> ` ���0��t 10/�/��.*?/�� (Name ofNotary Typed, Printed,or Stamped) <br /> ` ��QO� A��.�ynt % My Commission expires: <br /> - �yt� w�y�.: Personally Known x OR Produced Identification <br /> . <br /> _ . �ry . _ <br /> 'o� :o� <br /> i'. � ��`pQo <br />� %S���'• �di����i��Q��4�' (TypeofIdentificationProduced) <br /> o,o�,�i�idiii4 ii+i4°�`�`. <br />