Permit Authorization Form - Selig, Daniel
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Owner’s Authorization Form For Permit Applications
I hereby authorize Freedom Forever to file permit application(s) for project work as agreed upon between the Owner and the Owner’s Authorized Company
and its designated subcontractors.
Owner Name:
Project Address:
Signature:
Owner’s Authorized Company: Freedom Forever Massachusetts, LLC
Company’s Corporate Address: 43445 Business Park Drive, Suite 110, Temecula CA 92590
Affiliation: Contractor
State Home Improvement Contractor License: MA HIC 198080
State Electrical Contractor License: MA 902-EL-A1
State: Massachusetts
DocuSign Envelope ID: 4A5C7451-3D7F-4755-AF22-E0A0F74E3E16
67 Liberty St, Northhampton, MA 01062
Daniel Selig