20231063 Ver 1_Agent Authorization_20230801

Agent Authorization Form
Parcel ID: V6 2 S 11 1333
Street address: /yS' 4,ew 11ovew /W
?r..,t er„Ile N.C. z 8 / 17
(Please Print)
Property Owner: 547ISly 47-P4A/1)3
Property Owner:
The undersigned, registered property owners of the above noted property, do
hereby authorize Tina Little. To act on my behalf and take all actions necessary for
processing and issuance of this permit or certification and any and all standard and
special conditions attached.
Property owners address ( if different from above)
131 - b 13 1<e. [e v /Ice-.
d 00,4es ildlC ly.e. a-g117
Telephone #: .2o 3- S'] 1- R o 7 3
We hereby certify the above information submitted in this application is true and
accurate to the best of our knowledge.
0;7/P1Jz3
Authorized signature Date
it x'K` o Flo 1 (�3
Authorized signature Date