Special Power Of Attorney - City Of Orlando
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1
2Special Power of Attorney
I, _________________________
, license # _____________________,
(Name of License Holder)
hereinafter referred to as the “License Holder,” the ________________________________
, of
(title)
_______________________________
, hereinafter referred to as the “Company”, hereby
(Name of Company)
appoint the following persons as Attorney-in-Fact of the License Holder/Company, in order to (a) sign and
submit building permit applications, (b) obtain building permits, and (c) obtain the certificate of occupancy from
the City of Orlando on behalf of the License Holder/Company:
_________________________
___________________________
__________________________
_________________________
___________________________
__________________________
LICENSE HOLDER
WITNESSES:
Sign: __________________________________
Sign: _________________________________ ___
Print Name: ____________________________ _
Print Name: ______________________________
Title: __________________________________
Company Name: ___ ______________________
Sign: ___ _________________________________
Mailing Address: ___ ______________________
Print Name: _______________________________
______________________________________
Telephone No.: __________________________
Fax No.: ____ ____________________________
E-mail Address: ___ _________________________
State of ____________________________
County of _________________________ _
The foregoing instrument was acknowledged before me this ________ day of ________, 20___, by _________________,
the ______________________ of _______________________, a ____________________ corporation, on behalf of the
corporation. He/she is personally known to me or has produced _____________________ as identification.
___________________________________
Notary Public
Commission Expires:_____________________
Rev 07/2005
ECONOMIC DEVELOPMENT DEPARTMENT
PERMITTING SERVICES DIVISION
CITY HALL
400 SOUTH ORANGE AVENUE
FIRST FLOOR
P.O. BOX 4990
ORLANDO, FLORIDA 32802-4990
PHONE 407.246.2271 FAX 407.246.3420
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