Department of Growth Management Page 1 of 1 BF33 Power of Attorney
Building Division Revised August 25, 2008
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
Range Township Section Alternate Key #
Subdivision Block Lot
License #
Name of Certified Contractor (Type or Print)
Signature of Certified Contractor
State of Florida
County of Lake
, 20
,
The foregoing instrument was acknowledged before me this
day of
who is personally known to me or has produced by
as identification and who did _______ or did not ______ take an oath.
(SEAL)
Notary Public (Signature)