Seminole County Multi-Jurisdictional
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date:
I hereby name and appoint:
an agent of:
(Name of Company)
to be my lawful attorney-in-fact to act for me to apply for, receipt for, sign for and do all things necessary to this
appointment for (check only one option):
All permits and applications submitted by this contractor.
Or
The specific permit and application for work located at:
(Street Address)
Expiration Date for This Limited Power of Attorney:
License Holder Name:
State License Number:
Signature of License Holder:
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowledged before me by means of [ ] physical presence or [ ] online
notarization, this day of , 20 , by _____
(name of person acknowledging), who is personally known to me or who has
produced as identification and who did (did not) take an oath.
Signature of Notary Print or type Notary name
Notary Public - State of
Commission No.
(Notary Seal) My Commission Expires:
