Power Of Attorney And Authorization To Draw Construction Permits

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POWER OF ATTORNEY AND AUTHORIZATION TO
DRAW CONSTRUCTION PERMITS
__________________________
(1) Name of contractor
FROM:
(2) Type license held
__________________________
(3) County Reg. No.
(4) Name of individual who will permit
__________________________
Highlands County Building Department
TO:
Post Office Box 1926
Sebring, FL 33870
__________________________
DATE:
I, (1)___________________________, the holder of Highlands County (2)______________________ contractor license registration
number (3)__________________, hereby name, constitute, and appoint (4)__________________________, my attorney-in-fact for
the purpose of applying for and receiving permits in my name. I hereby represent and warrant to Highlands County that all work
performed under my supervision, and that I shall be fully responsible for the proper performance of said work.
(Check one of the following)
( ) This power of attorney and authorization to draw permits is limited to the job described
as _______________________________________________.
(type construction-location)
( ) This power of attorney and authorization to draw permits shall expire on_____________________.
(date of expiration)
( ) This power of attorney and authorization to draw permits shall continue in full force and effect until I deliver to you a letter
revoking the power.
________________________________
________________________________
Type of identification provided
Signature of Contractor
STATE OF FLORIDA
COUNTY OF HIGHLANDS
Subscribed and sworn to before me this _______ day of ____________20____.
_______________________________
Notary Public
_______________________________
Commission:
__________________________________
_______________________________
.
Type identification provided
Signature of designated attorney in fact
Subscribed and sworn to before me this _______ day of ___________,20________.
______________________________
Notary Public
______________________________
Commission:
Revised 03/19/93

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