20211682 Ver 1_Agent Authorization_20211118

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIMON:
LOT NO.
PLAN NO.. PARCELID:
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Please print:
Property Owner.,
Property Owner:
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The undersigned, registered property owners of the above noted property, do hereby authorize
((Contractor ; Agent} (Name of consulting firm-) J
to act on nay 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):
Telephone;%�� 1 S
We hereby certif yr the abode information submitted in this application is true and accurate to the
best of our knowledge.
U'
a J1;<•as�i`3a
Date:
Authorized Signature
Date: