20230601 Ver 1_Agent Authorization_20230427

AGENT AUTHORIZATION FORM
Property legal description
Lot No. 3 Plan No. Parcel ID:
Street Address`
Property Owner: /mil � �� � ��' 0-1
_. The undersigned, registered property owner of the above noted property, do
ereby authorize
Con or/ agent Business Name
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 from above):
r
1 i �� Q �nd ram. rt`e$�`� g
Telephone:` dA
We hereby certify the above information submitted in this application is true
and accurate to the best of our knowledge.
Authorize gnature Aut ed Signature
Date: !/- "f-ZoZ.Z
Date: