20230880 Ver 1_Agent Authorization_20230621

Agent ALIthorization Form
Parcel ID: VG3S-ZZ 3 F Z 3
street address: /'/ S `�� �.-.�.. /� A41
-?q o en x e s o,.'1I t o A/,O , 7 8' / I
(Please Print) levoProperty Owner: ,��,✓ . ,��,., �� ea `l IX -.f
Property Owner:
The undersigned, registered property owners of the above noted property, do
hereby authorize Tina Little. To act on my behalf and take all actions necessary for
processing and issuance of this permit or certification and any and all standard and
special conditions attached.
Property owners address ( if different from above)
L12 Dl Nr J84 /.je
Telephone -747: 7 J--
We hereby certify the above information submitted in this application is true and
accurate to the best of our knowledge.
Authorized signature
Authorized signature
Date
Date