Doc - Apr 21, 2023 - 3-05 PM 4-24-23

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO.
PLAN NO.
PARCEL ID: 962843178200000
STREET ADDRESS: 99999 Woodland Drive, Asheville, NC 28806
Please print:
Property Owner: Birch Cirde dates llc
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
Derek Butler P.E. of Wade Trim Inc.
(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):
P.O. Box 1038, Arden, NC 28704
Telephone: 6784M-4919
We Hereby certify the above information submitted in this application Is true and accurate to the
best of our knowledge.
Aut orized Signature �� Authorized Signature
Date: q f ? �' Z Date: