20230210 Ver 1_Agent Authorization Letter_20230216

LOT NO. _ PLAN NO. PARCEL ID: L*% L 3 l k
STREET ADDRESS: _L-S L3 ll Utj�- r-.A L 0 sue( t Ab g j
k A'X i w'j- %'-) c_ 'Z B'ZgG
Please print:
Property Owner: Lai to A-)
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
t` _
wt`�sr M es SS C II � , of - M os-% %A%+-4— (.0vt IIXQ C.R�V
(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):
k t a VIt N T -vet Act(. fid'v- 3�3 z,
Telephone: `� �� (yc-q
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
u
horized signature ,authorized Signature
Date: ,<I) l Date: `