State Certified Contractor Registration Form Page 3

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Escambia County Building Inspections Division
3363 West Park Place
Pensacola, FL 32505
Telephone: (850) 595-3550
Facsimile (850) 595-3401
INTERACTIVE VOICE RESPONSE (IVR): (850) 471-6640
On the Web:
LETTER OF AUTHORIZATION
$25.00 Fee
THIS LETTER OF AUTHORIZATION SUPERCEDES ALL PREVIOUS LISTS ON FILE UNLESS OTHERWISE INDICATED.
I CONFIRM THE FOLLOWING LISTED PERSON(S) ARE ON MY PAYROLL AND AUTHORIZED TO SIGN FOR
PERMITS RELATED TO ESCROW ACCOUNTS, IF APPLICABLE; REQUEST INSPECTIONS AND RECEIVE A
CERTIFICATE OF OCCUPANCY IN MY NAME. CONTRACTORS WHO SIGN THIS FORM ARE RESPONSIBLE
FOR ALL PERMITS AND ALL WORK PERFORMED UNDER THE CONTRACTOR’S LICENSE.
NAME OF AUTHORIZED PERSON
NAME OF AUTHORIZED PERSON
NAME OF AUTHORIZED PERSON
I UNDERSTAND THE COMPETENCY BOARD AND/OR BOARD OF ELECTRICAL EXAMINERS HAVE
POWER/AUTHORITY TO DISCIPLINE A LICENSED CONTRACTOR FOR VIOLATIONS COMMITTED BY
CONTRACTOR, HIS AGENTS, OFFICERS, OR EMPLOYEES AND I TAKE FULL RESPONSIBILITY FOR
COMPLIANCE WITH ALL STATUTES, CODES, AND LAWS INHERENT IN THE PRIVILEGE OF ISSUANCE OF
SUCH PERMITS.
IF AT ANY TIME PERSON(S) AUTHORIZED ABOVE ARE NO LONGER IN MY EMPLOY, I WILL SUBMIT AN
UPDATED AUTHORIZED LIST DELETING AND/OR ADDING AUTHORIZED AGENTS.
___________________________________________
_________________________________________________
PRINT CONTRACTOR’S NAME
CONTRACTOR’S SIGNATURE
____________________________________________
_________________________________________________
DATE SIGNED
LICENSE NUMBER
STATE OF _____________________
COUNTY OF ______________________
The contractor whose name is _______________________________________ personally appeared before me and presented
identification _________________________________________________________________ or is personally known to me; this
_____ day of ____________________, 20______.
_________________________________________
NOTARY PUBLIC (SEAL)
LICENSING & INVESTIGATIONS SECTION
CONTRACTOR LICENSING
Form 600.7
Revised 09/2010

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