AGENT-AUTHORIZATION-FORM

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:
303 Robert Street
Cary, NC 27511

Parcel ID:

Property Owner Name(s) – please print:

Property Owner: Jeanne Carol Olderman
Property Owner:

The undersigned, registered property owners of the above noted property, do hereby authorize

Melissa Schambs , of Schambs Realty Group – BHHS YSU Realty
(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):

Property Owner(s) Telephone: [phone]

We hereby certify the above information submitted in this application is true and accurate to the best
of our knowledge.

Jeanne Carol Olderman
Authorized Signature Authorized Signature
October 12, 2023
Date Date

DocuSign Envelope ID: B067D877-23A4-42E9-A2B9-17C1E96EF1F4
10/24/2023
0763394613
AKA Berkshire Hathaway HomeServices YSU Realty