20200760 Ver 1_More Info Received_20200608

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. 6 PLAN NO.
PARCEL ID: 1706255935
STREET ADDRESS: 1112 Wimbleton Dr., Raleigh, NC 27609
Please print:
Property Owner: John Therien
Property Owner: Heather Therien
The undersigned, registered property owners of the above noted property, do hereby authorize
Louis Cherry
(Contractor / Agent)
of Louis Cherry Architecture
(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):
O b L-AxN-aA ��cf P-W kt �. C 271�17-
Telephone: !3kek`713-92Al
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Signature
Date: (�2 g'
Authorized Signature
Date: �� Z�