20200914 Ver 1_More Info Received_20200908

AGENT AUTHORIZATION FORM
Property Legal Description
PIN: 133467, 133466, 133463
Address: NC HWY 135 — Eden, NC
Property Owner : Wanda Dyer & Susan Pace
Client : Teramore Construction, LLC
The undersigned, registered property owners of the above noted property, do hereby authorize
Derek Goddard , of BREC, PA
(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 all standard and special conditions attached.
Property Street Address (if different than property above):
We hereby certify the above information submitted in this application is true and accurate to
the best or knowledge.
zed Signature- Print and Sign
Date: rIlgr&G��