2023001 Ver 1_Bridges St Ext Agent Authorization_Signed_20221107

AGENT AUTHORIZATION FORM
Please note that multiple forms may be necessary if there are more than two owners of the property.
PROPERTY LEGAL DESCRIPTION:
STREET ADDRESS OF EXISTING HOME or LATITUDE/LONGITUDE OF NEW CONSTRUCTION:
4324 Bridges Street Ext
Morehead City, NC 28557
Parcel ID: 636616846448000
Property Owner Name(s) — please print:
Property owner: Wellons Grandchildren, LLC
Property owner: Gaye Wellons Mashburn, Registered Agent
The undersigned, registered property owners of the above noted property, do hereby authorize
Roy Brownlow of Tidewater Associates, Inc.
(Contractor/Agent)
(Name of company)
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 Owners Mailing Address (if different than property address above):
POB 1018, Morehead City, NC 28557
Property Owner(s) Telephone: Z-�',2' %z 4 - .2� 'f
We hereby certify that the above information submitted In this application is true and accurate to the
best of our knowledge.
Aunature ,
//, hl' A 2
Date
Authorized Signature