20220114 Ver 1_Agent Authorization_20220121

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO:
STREET ADDRESS:
PLAN NO:
PARCEL ID: 08 SEC14 20
5560 Gunpowder Rd ----
Granite Falls NC 28630 — -- --
Please print:
Property Owner: _ Carson Copeland _ ------
Property Owner:
The undersigned, registered property owners of the above noted property, do herebyauthorize
Charlie Washburn
(Contractor/Agent)
, of
Marine Construction LLC
(Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of this
permit or certification and any and all standard and special conditions attached.
Property Owners Address (if different than property above):
same
Telephone: [phone]
We herebv certify the above information submitted in this application is true and accurate to the
best of our knowledge.
U .
Authorized Signature
Date
Authorized Signature
Date