20231020 Ver 1_Agent Authorization_20230724 (2)

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRUMON:
LOT NO. PLAN No. — PARCEL ID:
snzr r Aos�: �3 G�s►i
Please orint:
Property Owner: �) tA-A ►ft nz> M
Pmpesty Owner;
V-a !Sa
Thee undersigned, registered property owners of U* above noted property, do hereby authorize
(Contractor j Agent) (Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of
0% permit or certification and any and al standard and spedal conditions attached.
Property 4wnWs Address (if different than property above):
Telephone. 5 t5 ..
We hereby Ter* the abm kiFornsation submitted in this application N true and acturate to the
best of our knowledge.
Authorized Signature
0