20221198 Ver 1_Sunnybrook HOA Agent form_signed_20220831

Agent Authorization Form
PROPERTY LEGAL DESCRIPTION:
1722184716' & 1722188472 &
LOT NO. PLAN NO. PARCEL ID: 1722185436 & 1722185828
STREET ADDRESS: PU ') Zoal6 q
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Please print:
P' Welty Owner. JQ.rflC$ L HOQS
&ic Wtofty dre..�s
The undersigned, registered property ovuners<o of the above noted property, do hereby: authorize
Simon Gregg of Kris Bass Engineering
(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 Address (if different than property above:
Property Owner:
Telephone: IN- (0 T6- toil
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
uthori d Signature
Date:
W" /
ti)
Authorized Signature
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Date: 7- 24 - yd-