20240004 Ver 1_23-455 - 74 Toxaway Landing - Seawall Replacement_20231215

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SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO.
PLAN NO. PARCEL ID: (�-4}22- T 2� - �L `Z -000
STREET ADDRESS: 1 �G K((Wf.{�f L-we' d tnC1 "bc-.
Please print: (J f
Property Owner:O
Property Owner: f� CL-`e4-,-) Ind e-- _
The undersigned, registered property owners of the above noted property, do hereby authorize
l�M r , of Cnw��ect ��UI U _ �i �'I;:ty ,�LLC_..
(Contractor / Agent) (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):
Telephone: 1 S 4 ~3 a S -" `-7 s 2-
We hereby certify the above information submitted in this application is true and accurate to the:
best of our knowledge.
Authorized
Sig ature
Date: !�
Authorized Signature
Date: [_ 1 - _