20230532 Ver 1_P22127-Webb AGENT_AUTHORIZATION_FORM completed_20230414

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
2
2
183119:93211111
LOT NO. ______________ PLAN NO. ____________ PARCEL ID: ________________________
626!Tpvui!Dbspmjob!Ufssbdf-!Cmbdl!Npvoubjo-!OD!39822
-----------------------------------
STREET ADDRESS: _____________________________________________________________
Montreat, NC 28757
_____________________________________________________
Please print:
JAMES L WEBB TRUSTEE
Property Owner: ________________________________________________________________
Property Owner: ________________________________________________________________
The undersigned, registered property owners of the above noted property, do hereby authorize
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__________________________________, of ________________________________________
(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):
978!Xfbuifstgjfme!Es-!Evofejo-!GM!457:9
_________________________________________________________________
)838*!691.7818
Telephone: _____________________________
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
JAMES L WEBB TRUSTEE
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__________________ __________________ _________________ __________________
Authorized Signature Authorized Signature
301703134
2-8-2023
Date: _______________________________ Date: _______________________________