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2. Please be advised this form is for customer use only. Building Services will not track, monitor or receive a copy of this request. Enter a valid email below to receive a copy for your processing.
4. I hereby authorize (name of company and individual being authorized)
6. to pick up permits and sign any documents related to:
8. Please choose one of the following:

   1. All Permits
   2. Address/Parcels #
   3. Permit#
10. Address/Parcel #
12. Permit #
14. Company Name (name of authorizing company)
16. Contractors License # (authorizing company's license number)
18. Qualifiers Name (authorizing company's license holder)
20. Qualifiers Signature_______________________________________________
22. The forgoing authorization letter was acknowledged before me this ___________ day of ________, 20____by____________________________
    
    
    ___who is personally known to me
    ___who has produced identification_________________________________________
    
    
    Notary Public Signature:______________________________________
    
    My Commission Expires ______________________________________
24. Email completed forms to planning2@sumtercountyfl.gov
26. Please be advised this form is for customer use only. Building Services will not track, monitor or receive a copy of this request. Enter a valid email below to receive a copy for your processing.
Leave This Blank:


27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit

* indicates a required field