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� <br /> ��1�o.�ni� <br /> _� � . <br /> � • ozniak Builders, Inc Business: (813) 377-4944 <br /> uild�ers p Box 326 Fax: 813-377-4945 <br /> _ - D de City, Fl 33526 WWW•WOZniakbuilders.com <br /> Building Better Lives <br />, City of Zephyrhills <br /> Perm t Authorization Form <br /> I,Victor Wozniak or Wozniak Construction, Inc C C1505145 <br /> Hereby authorize the following to act as my agent(s) in obtaining permits in City of Zephyrhills, FI. <br /> Ann Wozniak � <br /> Patrick Mc Donald <br /> Richard Patterson � <br /> This form supersedes any previously submitted I tter(s)of authorization. <br /> This authori ation will remain in effect until can elled in writing by the undersigned license <br /> holder. <br /> 6�.�� <br /> License Holder's Signature <br /> State of ��X_1�„��. <br /> County of <br /> Sworn to (or affirmed) and subscribed before me this <br /> I day of �1 , 20� <br /> ;=�`'�YP°°�: TINA P <br /> 4 ERRITT <br /> By ( , , y��� ts MY COMMISSION#FF052958 <br /> (Printed name of License Holder Makin Statement -•',?e� •"'op�s EXPIRES Se tember 10 2017 <br /> g ) ,or c�,,,,••� P � <br /> (407y 398-0153 FloridallotaryService.com <br /> No ary Public <br /> I Y <br /> (signature of Notary) <br />