20230523 Ver 1_Agent Authorization_20230418

AGENT AUTHORIZNFION FORM
LOT NO: — 79- Phase 2 PLAN NO:
U= �
Property Owner Dons Ahn
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
Charlie Washburn
I Of
Marine Construction U.0
(dame of wmiffing iir—m)
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.
(Mailing) 452 Boxwood Road Bryn Mawr, PA 19010
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate to the
3 1,A0,A3
Date