20211176 Ver 1_Agent Authorization Form_20210809

Strickland, Bev
From: Paul Sappie <[e-mail]>
Sent: Monday, August 9, 2021 4:25 PM
To: Cohn, Colleen M
Cc: Chase B
Subject: [External] Agent Authorization Form
Attachments: AGENT_AUTHORIZATION_FORM.docx.pdf
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Hi Colleen,
Attached is the agent authorization form you requested. My address for the form is
105 Marsden Ct
Cary, NC 27518
Paul Sappie
i

AGENT AUTHORIZATION FORM
Please note that multiple forms may be necessary if there are more than two owners of the property.

PROPERTY LEGAL DESCRIPTION:

STREET ADDRESS OF EXISTING HOME or LATITUDE/LONGITUDE OF NEW CONSTRUCTION:

Parcel ID:

Property Owner Name(s) – please print:

Property Owner:
Property Owner:

The undersigned, registered property owners of the above noted property, do hereby authorize

, of
(Contractor/Agent) (Name of company)

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 Owners Mailing Address (if different than property address above):

Property Owner(s) Telephone:

We hereby certify the above information submitted in this application is true and accurate to the best
of our knowledge.

Authorized Signature Authorized Signature

Date Date

DocuSign Envelope ID: 475C8B41-0BA2-4544-86DB-723CE01FCB05
Genesis Construction
7/27/2021
Paul Sappie
Paul Sappie
Chase Bolesky
7/27/2021