Office of Building Services Page 1 of 1 BF33 Power of Attorney
Revised September 29, 2017
POWER OF ATTORNEY
Date
I hereby name and appoint
to be my lawful attorney in fact to sign my documents pertaining to permits for the Lake County Building
Division. (Check and complete one of the following.)
To sign for any and all, documents until further notice.
OR
To this specific job for work to be performed at
Alternate Key # Section Township Range
Lot Block Subdivision
License #
Name of Contractor (Type or Print)
Signature of Contractor
State of Florida
County of Lake
The foregoing instrument was acknowledged before me this day of , 20 ,
by who is personally known to me or has produced
as identification and who did _______ or did not ______ take an oath.
(SEAL)
Notary Public (Signature)
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signature
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signature
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