1101 EAST FIRST STREET SANFORD FL 32771-1468 PHONE (407) 665-7050 FAX (407) 665-7486
bpcustomerservice@semiolecountyfl.gov
SIGNATURE ACKNOWLEDGEMENT FOR ePLAN
Please allow this letter to serve as the signature of record for ePlan permits
applied for in unincorporated Seminole County.
License:
Registered to:
Company:
This letter is effective from: to:
(No longer than one year from effective date)
By signing this document I acknowledge the following items:
This document will be submitted and/or uploaded with each permit
application package.
As the license holder, I am submitting or uploading the necessary
document(s) and/or drawing(s) required for the permit application
package. If I elect to have another individual act on my behalf I will
provide a notarized Power of Attorney for that individual.
Printed Name Signature
STATE OF FLORIDA )
COUNTY OF ____ )
Sworn to and subscribed 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 [ ] has produced __________________________ as identification.
_________________________________________
Signature of Notary Public (Seal)
