20231083 Ver 1_Agent Authorization_20230807

PREMIER PERMITS
OF THE CAROLINAS LLC
PROPERTY OWNER INFORMATION
PROPERTY OWNER:
Denise Straus
PHONE:
770-241-8433
EMAIL:
[e-mail]
WORK SITE ADDRESS:
976 Astoria Pkwy
Lot 3
Catawba, NC 28609
MAILING ADDRESS (if different than property above):
12190 Charlotte Dr.
Alpharetta, GA 30004
The undersigned, registered property owners of the above noted property, do hereby authorize
Erica McIntosh , of, Premier Permits of the Carolinas, LLC
(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.
We hereby certify the above information submitted in this application is true and accurate to the best of our knowledge.
Authorized Homeowner Signature Authorized Agent Signature
Date: Date: 5 30 23