682 Berry Hill Drive

PROPERTY LEGAL DESCRIPTION:
LOT NO. 307 & 308
AGENT AUTHORIZATION FORM
PLAN NO. PARCEL ID: F574f1M47C1(l5
STREET ADDRESS: 682 Berry Hill Drive
Norwood NC 28128
Please print:
Property Owner: _ Shelby -H Smith
Owner:PhilopA Smith
The undersigned, registered property owners of the above noted property, do hereby authorize
Jeff Page of
(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 Owner's Address (if different than property above):
5431 Linmac Farm Rd, Oakboro NC 281.2.9...______
Telephone: Shelby Smith [phone]
Philip Smith [phone]
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Autho d Signature
Authorized Signature
0811=13 Date: 08/10Z2Q23