20231067 Ver 1_Agent Authorization_20230802

AGENT 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:
1771 Scenic Ln, Granite Falls, NC 28630
35.779/-81.552
Parcel ID: 11 55A 1234
Property Owner Name(s) — please print:
Property owner: James Yucha
Property Owner: Kim Yucha
The undersigned, registered property owners of the above noted property, do herebyauthorize
Charlie Washburn , of Marine Construction LLC
(Contractor/Agent) (Name of company)
to act on my behalf and flake 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):
1221 Forestdale Drive, Salisbury, NC 28144
1221 Forestdale Drive, Salisbury, NC 28144
Property Owner(s) Telephone: [phone]
We hereby certify that the above information submitted in this application is true and accurate to the
Authorized ibnature
best of our knowledge.
Contractor/Agent
Date