20221198 Ver 1_3312 Sunbright Agent form_signed_20220831

Agent Authorization Form
PROPERTY LEGAL DESCRIPTION
LOT NO. PLAN NO. PARCEL ID: 1722184845
STREET ADDRESS: 3312 Sunbright Lane Raleigh, NC 27610
Please print:
froperty`Owner:
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Property Owner:
The undersigned, registered property- ous, ers of the above noted property,, do hereby; authorize
Simon Gregg
(Contractor / Agent)
of Kris Bass Engineering
(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 Address (if different than property above):
NLI Jr \ s bc. .t, t h-4-dkailc NC 2.7 S
Telephone: 2_0 S-Z
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Au orized S'gnatu - U Authorized Signature
Date.: Z
22. 2O?-i
Date,: