20230439 Ver 1_Agent Authorization Letter_20230419

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION
LOT NO. tl"A PLAN NO. r' 14 PARCEL ID:
STREET ADDRESS:
Please print:
Property Owner: N
,—Du=Shpwd 6Y
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
Ai SEA (,-CC of S M C.S CCii—sc:C��C�
(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):
191 C Ub �o1, C, ainoLq- :q
RR
Telephone: _�7 — T 6o _a, UL
We hereby certify the above information submitted in this application is true and accurate 10 the
best of our knowledge.
D, S,gn d by
Authorilg{ ivnaFure Authorized Signature
Date: 4/19/2023 — - — Date: y— /1
-_ _--