Permit Agent Authorization Form printable pdf download

Permit Agent Authorization Form

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.

Permit Agent First and Last Name

Driver’s License #

This form supersedes any previously submitted letter(s) of authorization.

This form must contain only the people you want to pull permits in your name. To make changes to this form, you must submit a new

form. This form will delete and replace any previous authorization form and the information contained thereon.

License Holder’s Signature:

______ Date:

State of:

County of:

Before me, personally appeared,

, who produced

as identification or is personally known to me, and who did affirm and subscribed before

me this

day of

, 20

Affix Seal

Signature of Notary Public

Stamp

Name of Notary Typed, printed or stamped

My Commission Expires:

HCFLGov.net

Permit Agent Authorization Form