20230941 Ver 1_Agent Authorization_20230706

AGENT AUTHORIZATION FORM
Please note that multiple forms may be necessary if there are more than two owners of the property.
PROPERTY LEGAL DESCRIPTION:
STREET ADDRESS OF EXISTING HOME or LATITUDE/LONGITUDE OF NEW CONSTRUCTION:
5218 Peninsula Dr. Granite Falls, NC 28630
35.801 /-81.332
Parcel ID: 081471 39
Property Owner Names) — please print:
Property Owner: James Rasmussen
Property owner: Debra Rasmussen
The undersigned, registered property owners of the above noted property, do herebyauthorize
Charlie Washburn , of Marine Construction LLC
(Contractor/Agent)
(Name of company)
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 Mailing Address (if different than property address above):
10723 Admirals Lassie Lin Berlin MD 21811
10723 Admirals Lassie Ln Berlin MD 21811
Property Owner(s) Telephone: [phone]
We hereby certify that the above information submitted in this application is true and accurate to the
best of our knowledge.
Y
Atrinorized signature Authorized Signature
June 28, 2023 June 28, 2023
Date Date