HomeMy WebLinkAboutCONTRACTOR AUTHORIZATION FORMt
CONTRACTOR AUTHORIZATION FORM ��� 1/�
0o0
TATE LICENSE NO.: EC13001255 �61
RINT QUALIFIER'S NAME: DANIEL YATES
GULF ELECTRICAL SERVICE
USINESS NAME:
orize the following individuals to sign for and obtain permits: (Please print names clearly.)
EBORAH PLATTHY
'ACY GRAVES
B HODGES
ignature of Qualifier: Date: 9/27/18
Sltate of Florida
County of
Sworn to and subscribed before this day
(stamp) 4-7-19
M commission expires
9/27/18
R—�/M—o
• i 111111 • • jr: 111111111111 •.
Aq @N
f
Notary public State of Flonda
Timothy Coffey
Commission
? •rw
E. GG 248871
Expires 08/15/2022