20230895 Ver 1_Agent Authorization_20230623

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTIOW:LL��
LOT NO. �- � �°_-- PLAN NO. _-� r � PARCELID: -- - --
STREET ADDRESS:
Please print:
Property Owner:
Property Owner:
The undersigned, registered.property owners of the above noted property, do hereby authorize
i !�✓�yof
EContractor / Ag4) � (Name of consdlbng 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):
Telephone: % 44 y rj,� -
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
ethonzed Signature
Date:'���
AA-
Autho Signature
Date: 61zolzo ��