20230700 Ver 1_Kolls - signed Agent Authorization Form - 5.11.23_20230516

AGENT AUTHORIZA170N FORS
PRaPERTY ' FGAL aESCRI7no a
LOr NO. � 014 — PLAN 140. PARCEL Its; Z04`,
MEET.Al DRSS.
W
P16ase prir►.-
Rro Owner: t N0 1SO L L
The undersigned, registered property owners of the above nc7ted property, do hereby audxxize
(Contractor /Agent) (Nanx of c nsulfdng firm) 4q
QZ
to act on my behalf and take all actions necessary for the procezinq, issuance and acceptance of
thi;permit or oertfication and any and a I I standard and special conditions attached..
Pro Ontw`s Ad if dftfpt
Rffpt than
� property
,U� above):
Teeptwea
We here-by certify the above infumnation su:xmlt'ted in this application is:rue and accurate to the
best at our Icnc edg .
Atthoded 5i re ed&gnawte
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Date:
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