20200564 Ver 1_JNX_Agent_Authorization_Form_Signed_20200423

JNX AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION :
No. 15079017D
LOT N0. PLAN NO. PARCEL ID: PIN: 168500-12-1015
STREET' ADDRESS: Johnston Regional Airport (JNX): 3149 Swift Creek Road
Smithfield, NC 27577
Please print:
Property Owner:
Property Owner:
Johnston County Airport Authori
Philip Lanier (Airport Director
The undersigned, registered property owners of the above noted property, do hereby authorize
Adam Karagosian
(Contractor /Agent)
of WSP USA, Inc
(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):
Telephone:
919-934-0992
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Au
Authorized Signature
Date: