20230829 Ver 1_Agent Authorization_20230613

Agent Authorization Form
Parcel ID: !I Y6 .2 /D( 737
Street address: q.2X ,C,9ke v.'.e ,j S1.Ae: tole
`21d-o,"s„Ile Ali' ZS117
(Please Print)
Property Owner:
Property Owner:
The undersigned, registered property owners of the above noted property, do
hereby authorize Tina Little. To act on my behalf and take all actions necessary for
processing and issuance of this permit or certification and any and all standard and
special conditions attached.
Property owners address ( if different from above)
1�0 a Ite y,GW �J 4,t<S
-M oo`e-s v,'!/e , Ne.
Telephone #: V - rb�/- ZZQ�
We hereby certify the above information submitted in this application is true and
accurate to the best of our knowledge.
4awl &Z�� 0�LIIL,2-0Z3
Aut ized signature Date
Authorized signature Date