Agent Authorized Form 5-12-23

Agent Authorization Form
Property Legal Description:
Parcel ID: 962843178200000
Street Address: 99999 Woodland Drive, Asheville, NC 28806
Project Owner: TR 36 Woodland Drive, LLC
The undersigned, registered project owners of the work to be conducted on the above parcel, do hereby
authorize
Derek Butler P.E. . of Wade Trim inc.
to act on my behalf and take all actions necessary for the processing, issuance, and acceptance of this
permit or verification and any and all standard and special conditions attached.
Project Owner' s Address
6260 Avalon Blvd Alpharetta, GA 30009
Phone: [phone]
We hereby certify the above information submitted in this application is true and accurate to the best of
our knowledge.
Authdrize Signature
Date:
Authorized Signature
Date: