20230704 Ver 1_Agent Authorization_20230520

AGENTTHORIZAT FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO: 215 PLAN NO: PARCEL ID: 2764-78-3040
STREET ADDRESS:
1056 Pegasus Dr, Connelly Springs, NC 28612
Please print:
Property Owner: William Biggers
Property Owner: Kate Kovats
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)
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Client ignature Charlie Washburn
,;5I U I 7oz 5 5l1(1/93
Date Date