20220236 Ver 2_Agent Authorization_20230720

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. _ PLAN NO. PARCELID:
STREET ADDRESS: 33!s L)1 iev 1ew %OYeS LCDim
COcx)f ts \j" I ),t ML �`b I I-�
Please print:
PropertyOwner: 3--e—�V 1
3.4-reY Io'nA
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
of CSC 6-1kne cl; nu,LLC.
(Contractor / Agent) (Name of consulting 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 Owners Address (if different than property above):
Telephone: 110CI' Soo — (D% l3
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Signature
Date: