20230411 Ver 1_Agent Authorization_20230320

AGENT AUTHORIZATION FORM
PROPERTY LECAL DESCRIPTION:
LOT No. Lod q PLAN NO. PARCEL ID: Q IQ
STREET ADDRESS:
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Please print:
Property Owner:
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
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of
(Contrador I Agent) (Name of consuilting firm) + LLC-
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of
this peffnit or certification and any and all standard and special conditions attached.
PrO,PertY Owner's Address if different than property above):
Bel (2 v-rdrl CD r -,-,I -. QG tkC- ',1 (:3
Tel 6 .18 1- 5 1 H 5 1 T
We hereby certify the above information submitted in this aPplication is true and accurate to the
best of our knowledge,
Authorized ignature
Date:
Authorized Signature
Date;