City of Anna Maria BUILDING DEPARTMENT 10005 GULF: DRIVE ANNA MARIA, FL3 34216 TEL: 941-708-6132X25/F: 941-708-6136 Contractor/Agent Authorization Form  LORIDA  Date:  do hereby authorize to act as my agent In  securing permits in the City of Annal Maria for the period of  through,  lunderstand that! lam responsible fora any permits secured by my agent. Ifurther understand that each time my agent applies for ap permit, he/she must showi this authorization form to the permitting staff.  THIS AUTHORIZATION WILL STAND FOR1 THE PERIOD GIVEN. ABOVE.  Contractor's signature_ Name of Business  phone #  State registration / certification number  Agent's signature State of  phone #  County of  The foregoing instrument was acknowledged before me this  day of  20__by (contractor's name). has produced asl dentification oath. Notary Public Signature:, Printed Name of Notary: My commission expires:  who Is personally known to me or who  and who did/did not take an  Commission #