20231025 Ver 1_Agent Authorization_20230725

ENT 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:
2233 Pike Peak Ridge, Connelly Springs, NC 28612
35.782/-81.458
Parcel ID: 2774180539
Property Owner Names) — please print:
Property Owner: L. Brooks Gore Living Trust
Property Owner: Susan & Brooks Gore
The undersigned, registered property owners of the above noted property, do herebyauthorize
Charlie Washburn
(Contractor/Agent)
,of Marine Construction LLC
(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):
378 Race St. Charleston, SC 29403
378 Race St. Charleston. SC 29403
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.
Authorized Si nati e 1 ru5+e
-a
Date
Contractor/ Agent
NO/a3
Date