Power of Attorney

LIMITED POWER OF ATTORNEY

Altamonte Springs, Casselberry, Lake Mary, Longwood, Oviedo, Sanford,
Seminole County, Winter Springs

Date: ______________

I hereby name and appoint: ___________________________________________________________
 

an agent of: __________________________________________________________________________
                                                                        (Name of Company)

to be my lawful attorney-in-fact to act for me to apply for, receipt for, sign for and do all
things necessary to this appointment for (check only one option):


 All permits and applications submitted by this contractor.
 The specific permit and application for work located at:


______________________________________________________________________________________
                                                                 (Street Address)

Expiration Date For This Limited Power Of Attorney: ____________________________________

License Holder Name: _________________________________________________________________

State License Number: _________________________________________________________________

Signature of License Holder: ___________________________________________________________

STATE OF FLORIDA
COUNTY OF
_______________

The foregoing instrument was acknowledged before me this _____ day of _______________,
20___, by __________________________________________who is personally known to me/
or who has produced ____________________________________________________________
as identification and who did/did not take an oath.
 

_____________________________________________
                             Signature
 

_____________________________________________
                   Print or Type Name

(Notary Seal)
 
 
 

Commission Number: ___________________________
My Commission Expires: ________________________