20230906 Ver 1_Agent Authorization_20230627

Agent Authorization Form
Property Legal Description:
Parcel ID: gLiE)5E ` (d'E
The undersigned, registered property owner of the above noted property, do hereby authorize
To act on my behalf and take all actions necessary for processing, issuance and acceptance of this permit
or certification and any and all standard and special conditions attached.
Property owners address if different than above:
Telephone: CIA �?)s U IS
'
We hereby certify the above information submitted in this application is true and accurate to the best of
our knowledge.
Authorized Signature Date