20141084 Ver 1_More Info Received_20141022

t Lb
AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION.
LOT NO. PLAN N0, PARCEL ID: 04931102A
STREET ADDRESS: 9201 University City Boulevard, Charlotte, NC 28223
Please print,
Property Owner, The University of North Carolina at Charlotte
The undersigned, registered property owners of the above noted property, do hereby authorize
Chris Tinklenberg, PWS , of Kimley -Horn
(Contractor / Agent) (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 Owner's Address (if different than property above).
Facilities Management, UNC Charlotte. 9201 University Citv Blvd. Charlotte. NC 28223
Telephone 704 - 687 -0522
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge
a
s
Aut6onzed Signature i joky JA,
Date