20230522 Ver 1_Agent Authorization_20230418

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO: C-1� 0055 PLAN NO:
Pai a-1 i
STREET ADDRESS:
211 Rocky View Rd, Taylorsville, NC 28681
Please print:
Property Owner: Derek Light
Property Owner:
PARCEL ID: 0002302
The undersigned, registered property owners of the above noted property, do herebyauthorize
Charlie Washburn , of Marine Construction LLC
(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 Owners Address (if different than property above): (Mailing) I' ROC KNI U l e i ) 4+_ �1 wsy1�, NC U (A l
Telephone:
[phone]
We hereby certify the above information submitted in this application is true and accurate to the
Charlie Washburn
Date