20231039 Ver 1_Agent Authorization_20230726

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO: 24 PLAN NO:
STREET ADDRESS:
334 Marietta Road
Mooresville, NC 28117
Please print:
Property Owner: Carol Johnson {Seth Johnson
Property Owner:
PARCEL ID: 4639144577
The undersigned, registered property owners of the above noted property, d❑ herebyauthorize
DONNA P HRKO , of LANCASTER'S CUSTOM DOCK & LIFT SYSTEMS,
INC.
(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: [phone]
We hereby certify the above information submitted in this application is true and accurate tothe
best of our knowledge.
Authorized Sign t e Authorized Signature
6-1-2023
Date Date