20240012 Ver 1_Site Plan_20240102

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PREMIER PERMITS
OF THE CAROLINAS LLC
PROPERTY OWNER INFORMATION
PROPERTY OWNER:
Mark Howard
PHONE:
704-905-3203
EMAIL:
[e-mail]
WORK SITE ADDRESS:
508 Nivens Cove Rd
Mount Holly, NC 28210
MAILING ADDRESS (if different than property above):
The undersigned, registered property owners of the above noted property, do hereby authorize
Erica McIntosh, of, Premier Permits of the Carolinas, LLC
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of this permit or certification,
any and all standard and special conditions attached.
We hereby certify the above information submitted in this application is true and accurate to the best of our knowledge.
Authorized Homeowner Signature Authorized Agent Signature
Date: Date: