Laserfiche WebLink
Division 2 -Technical Provisions, IRC -1639 <br />Under penalty of perjury, PERMITTEE declares that it has read the foregoing affidavit and the facts <br />stated in it are true. <br />Permittee: <br />Authorized Signature: <br />Printed Name: <br />Date: <br />Work Telephone: <br />Mobile Telephone: <br />Email Address: <br />STATE OF <br />COUNTY OF <br />FURTHER AFFIANT SAYETH NAUGHT <br />(If signing as Owner's Agent, attach Letter of Authorization to Sign from Owner) <br />********************************* <br />Sworn to (or affirmed) and subscribed before me by means of ❑ physical presence or ❑ <br />online notarization, this day of 20 , by <br />(name of person making statement). <br />(Signature of Notary Public - State of Florida) <br />(Print, Type, or Stamp Commissioned Name of Notary Public) <br />❑ who is personally known to me or ❑ who has produced <br />as identification. <br />++ END OF SECTION ++ <br />Division 2 —Technical Provisions - 01025-14 <br />F:\PublicWorks\ENGINEERING DIVISION PROJECTS\1639 69th Street 66th Avenue to US -1 Resurfacing (SCOP)\1-Admin\Bids\Bid Documents - Advertisement\DIV <br />2 TECHNICAL PROVISIONS - IRC-1639.docx <br />