20201735 Ver 1_Agent Authorization_20210222

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mcgill
AGENT AUTHORIZATION FORM
Shaping Communities Together
PROJECT NAME: City of Boiling Spring Lakes Dams Construction/Reconstruction Project
PROPERTY LEGAL DESCRIPTION: City of Boiling Spring Lakes
PARCEL ID. 157HJ01401,142PA032,156EA058,1720000215,1720000208,142JG003,142JG002
STREET ADDRESS: N/A — Existing Dams (Sanford, Pine Lake, Upper Lake, and North Lake Dams)
Please Print
Property Owner/Representative: City of Boiling Spring Lakes
(If Representative) Title: Jeff Repp (City Manager)
The undersigned, registered property owners of the above noted property, do hereby authorize
Jon Swaim of McGill Associates P.A.
(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/Representative's Address (if different than property above):
9 East Boiling Spring Rd. Boiling Spring Lakes, NC 28461
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate to the best of our
knowledge.
Digitally signed by Jeffrey E Repp
Jeffrey E Repp Dal', 0o I=jr,pp o °rq -55ri 9
Authorized Signature
Date:
Authorized Signature
Date:
1013 STATE FARM ROAD, BOONE, NORTH CAROLINA 28607 1 828.386.1920 1 www.mcgillassociates.com