DENR Agent Authorization Gaddy signed.pdf

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. 84 PLAN NO PARCEL ID: 657501293027
STREET
ADDRESS: 135 Brightwood Court Norwood NC 28128
Please Print:
Property Owner: Tyler Gaddy
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
Roxane Allen
of Cohen Construction Inc.
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:
4408 Ansonville Road Marshville NC 28103
Telephone. [phone]
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Signature Authorized Signature
Date: 08.03.23 Date: Xaeitar