20211450 Ver 1_Agent Authorization_20211004

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO:
4,o-r 7 PLAN NO: ��; r � PARCELID: 61. � 6 -ZL I
STREET ADDRESS:
7*fLA-4� (,,j /'
1/ ✓&4-�� -2-90?Y
Please print:
Property Owner:
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Property Owner:
The undgrsigned, registerq property owners of the above noted property, do herebyauthorize
C— of �o 6j
(Contract r/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 Ownefs Address (if different than property above):
Telephone: �� 1 %J I �S
We hereby certify the above information submitted in this application is true and accurate tothe
best of our kno dge.
A horized ignature Authorized Signature
C'v-Z'Y
Date f Date