20240153 Ver 1_Agent Authorization_20240125

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. n/a PLAN NO. n/a
PAR ID: 657079635600. 6571412818000, 6571411987000, 6571421098000 NC PINS)
DEED BK: 709, PAGE: 395-399
DEED BK: 711, PAGE: 35-39
DEED BK: 721. PAGE: 474-477
STREET ADDRESS: 16581 NC Hwy 55, Merritt, NC 28556
Please print:
Property Owner: Cutter Bay Development, LLC.
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
John G. Thomas. PE , of Thomas Engineering, PA
(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):
3675 Marine Drive, Greenville, NC 27834 (office)
Telephone: [phone] (mobile)
I hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
William G. Garner, Manager — Cutter Bay Development, LLC.
17i
& tle
Authorized Signature
Date: f .