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Permit Authorization Form - Selig, Daniel 1 | Page 1 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