Fillable Limited Power Of Attorney - City Of Port Orange printable pdf download

Limited Power Of Attorney - City Of Port Orange

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CITY OF PORT ORANGE

COMMUNITY DEVELOPMENT DEPARTMENT

BUILDING DIVISION

1000 CITY CENTER CIRCLE

PORT ORANGE, FLORIDA 32129

TELEPHONE 386-506-5602

FAX 386-506-5699

LIMITED POWER OF ATTORNEY

I hereby authorize ______________________________________ to drop off and pick

up permits on my behalf, upon presentation of a notarized copy of this letter, for the

construction project at _____________________________________________for the

following licensed contractor: Business name________________________________

Qualifier Name _______________________________License# _________________

Qualifier Signature_____________________________________________________

STATE OF FLORIDA COUNTY OF _______________

The foregoing instrument was acknowledged before me this _____day of_________,

20____ by _________________________________________, who is personally known

to me or has produced _________________________as identification.

___________________________________

Notary Public Signature

My Commission Expires: ______________________________

Limited Power Of Attorney - City Of Port Orange

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