20230660 Ver 1_Agent Authorization_20230508

AGENT AUTHORIZATIU
PROPERTY LEGAL DESCRIPTION:
LOT NO: _ 10 PLAN NO: PARCEL ID: 08122210
STREET ADDRESS:
5753 Lake Pointe Dr. Granite Falls, NC 28630
Please print:
Property Owner: John Hines
Property Owner: Sharon Hines
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) 8870 Route 28 Brockway PA 15824
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate to the
best qf our knowledge.
b(
lient Signature Charlie Washburn
-a�i-a3 5�oi-a3
Date Date