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Permit Agent Authorization
I, __________________________________________ ____________________________________________
(License Holder’s Name NOT Company Name) (Contractor’s License #)
hereby authorize the following to act as my agent(s) in obtaining permits in Hillsborough County, Florida.
Currently authorized agents will remain on file.
It is the responsibility of the License Holder to notify this office of agent removals.
License Holder’s Signature: ______ Date:
STATE OF FLORIDA
COUNTY OF HILLSBOROUGH
Sworn to (or armed) and subscribed before me by means of
o
physical presence or
o
online notarizaon, this
________ day of __________________________________ , _________________ , by___________________________________________________ .
(day) (month) (year) (name of person acknowledging)
o
Personally Known OR
o
Produced Idencaon _________________________________________________________________
(Signature of Notary Public - State of Florida)
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Type of Idencaon Produced
_________________________
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(Print, Type, or Stamp Commissioned Name of Notary Public)
(Notary Seal)
________________________________________________________________
(Commission Number) (Expiraon Date)
HCFLGo
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