NCC233034_FRO Submitted_20231030

UNIVERSAL TECHNOLOGY PARK
FORZA PROJECT MARINE Agent or Landowner
Authorization
•
A. Property Legal Description. .
Parcel III(PIN): 171(1'73'8736
Address(es): 100 Impact Drive,Marion,NC 28752
Project Name: Universal Technology Park Forza Project Marine
B. Owner Information
The undersigned,registered pmp rty owner(s)of the above noted property,do hereby authorize
Contracto 1DeveloperiAgent teIew of
Forza XI,Inc_ (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.
1. Property Owner Name: MCDOwell County
Address(If different from project): 60 E Court Street,Marion, NC 28752
Telephone: 82r 76 7, E awootenQa mcdowellgovv.com
Signature: iff �` Date: _23
2. Property Owner Name:
Address(If different from project):
Telephone: Email:
Signature: Date:
C. )Notary `
I \!i c*0,r-x0 ,s Notary Palk P for the County of e, -W6.
State of Nks--\h ��z iTNOL- ,hereby certify that k \-< (1-- \kNIL)r5i---ers. personally
appeared before me this day and under oath acknowledged that the above form was voluntarily executed by him/her
and Is correct to the best of his knowledge and belief.
Witness my had and seal,this day of t'AC< ,26 3 YICTOfiff!CRAIG
Notary\JAt Mgt N€3TARYPUBLIC
hilt:Dm/an County
My Commission Expires AVM-k a 5-r i� �� North Carolina
J My Commission ExpirasAugust 16.20'27