20240590 Ver 1_Agent Authorization_20240423

AGENT AUTHORIZATION FORM
Please note that multiple forms may he necessary if there are more than two owners of the property,
PROPERTY LEGAL DESCRIPTION;
STREET ADDRESS OF EXISTING HOME or LATMDE/LONGrWDE OF NEW CONSTRUCTION:
1772 Scenic Ln Granite Falls, NC 28630
5.779/-81.555
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Parcei ID: 11 55A 1230 _..._
Property Owner Names) - please print:
Property Owner: Matthew Graham
Property Owner: Joan Graham _._-._..
The undersigned, registered property owners of the above noted property, d❑ herebyauthorize
Charlie Washburn , of Marine Construction LLC
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(Contrador IAgent) _
{Name of company}
to act on my behalf and take all actions necessary for the processing, issuance and aCoe ptanceof this
Permit or certification and any and all Standard and special conditions attached.
Property Owners Mailing Address (if different than property address above):
210 James Doak Pkwy Greensboro NC 27455
Property Owner(s) Telephone: [phone]
We hereby certify that the above information submitted in this application is true and accurate tothhe
best of our knowledge.
tized
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9 Authorized Signature r� — -- —
jo
ate Date ......- -