20150135 Ver 1_Agent Authorization Letter_20150804

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. PLAN NO. PARCEL ID: 9649 -61 -1183
STREET ADDRESS: 99999 South Charlotte Street, Asheville, NC 28801
Please print:
Property Owner: Rusty Pullium, Pulliam Spake, LLC
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
C. Chris Day, P.E.
(Contractor / Agent)
of Civil Design Concepts, P.A.
(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):
2 Walden Ridge Drive, Suite 70, Asheville, NC 28803
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
W �
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Aulfiorized Signature Authorized Signature
Date: /.y/i L h V Date:
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