20230749 Ver 1_More Info Received_20230718 (2)

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AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION.
LOT NO. 1 4v 1 (; .
PLAN N0.
PARCEL ID:
STREET ADDRESS: 7317 Webbs Chapel Cove Ct. Denver MEMO NIII C SIMON 2111111 8IN 11 037
Please print:
Property Owner: Brandon OBrien
Property Owner:
Ttte undersigned, registered property owners of the above Hated property, do hereby authorize
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(Gantractor j
of
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(Name of consulting frm)
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to aet on my behalf and take all actions necessary for the processing, issuance and acxept�inte of
this permit or certification and any and all standard and special conditions attached.
Property Owner's Address (if different than property above:
Telephone: [phone]
W� hereby certify the above information submitted in this applicafiiAn is true and accurafie fio the
best of our knvvvledge.
Ruth
Date: 7-17-23
Authorized Signature
Date: