20201735 Ver 2_Signed Agent Authorization Form_20220303

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AGENT AUTHORIZATION FORM
PROJECT NAME:City of Boiling Spring Lakes Dams Construction/Reconstruction Project
PROPERTY LEGAL DESCRIPTION: City of BoilingSpring Lakes
PARCEL ID. 157HJ01401,142PA032,156EA058,1720000215,1720000208,142JG003,142JG002
STREET ADDRESS: N/A –Existing Dams (Sanford, Pine Lake, UpperLake, and North Lake Dams)
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PropertyOwner/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’sAddress (if different than property above):

9 East Boiling Spring Rd. Boiling SpringLakes, NC 28461 ___________________________
_________________________________________________________________
Telephone: [phone]
We hereby certify the above information submitted in this application istrue and accurate to the best of our
knowledge.
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__________________ __________________ _________________ __________________
Authorized Signature Authorized Signature
:02103131
Date: _______________________________ Date: _______________________________
1013 STATE FARM ROAD, BOONE, NORTH CAROLINA 28607 | 828.386.1920 | www.mcgillassociates.com