20230713 Ver 1_Agent Authorization_20230522

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. C---AAS-i--- PLAN NO PARCEL lDi
STREETAXPESS It-(h
PPlease prfirt
ropert I y C)wref:
Property Owner. ---------- --------- - --------------._.
1"he unde[sinneo, ea[STered property owners of the above noted property do hereby auThorize
P l
�Clkvvj ---------------
,,-ta (Contr��- , / Agent) (Name of consuiting firm)
o act on nny behalf and take allactions necessary for the processing, issuance and acceptance of
'hi, permit or cer-tricauar, and any and all standard and special conditions attached
Property Owner's Address (if different than property above):
--------------- ------------------------ ----------- ----------
TelePhone
We hereby --er-[,Tv the above information submitted in this @PPI[C3tion is inie and accurate to the
best of our knowledge.
-- ----------- ------------ ----
Autorizea Signature�t6 :Of ized Sicnat,�ir x,
site
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