20231085 Ver 1_Agent Authorization_20230807

Al,i,tlt Authorization Form
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r city Owner:;
F .-opem, Owner:
^e 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
p-ocessing and issuance of this permit or certification and any and all standard and
special conditions attached.
Property owners address ( if different from above)
Telephone #:
We hereby certify the above information submitted in this application is true and
accurate to the best of ouphowledge.
orizedsigriature / Date
Authorized signature Date