20221591 Ver 2_Agent Authorization_20230406

PROPERTY LEGAL DESCRIPTION:
LOT NO.
STREET ADDRESS:
AGENT AUTHORIZATION FORM
PARCEL.ID: Qb Z
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Property Owner: i 1�' } NA
Property Owner: i GkUy�k m oy-A l?S
The undersigned, registered property owners of the above noted property, do hereby authorize
Awl (� V1-(1 (4 -�c 6641
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(Contractor I Agent) (Nature of consulting firm) "' Pivir k rl
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):
Telephone:
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
V
Authorized Signature
Date; 03/27/2023
Authorized Signature
Bate: