20240346 Ver 1_Agent Authorization Form- CreekStone1.0_20240227

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Agent Authorization Form
Property Legal Description:
Lot#: Parcel ID:
Street Address: 3 ck
Property Owner: `1 (�- Iv �- .P 1
Property Owner:
The undersigned, registered property owners of the noted property, do hereby authorize
of LL(
(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 Owners' Address (if different than property above);
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P \
Telephone: U
We hereby certify the above information submitted in this application is true and accurate
to the best of our knowledge.
Authorized Signature
Date: 91 6 .,_
Authorized Signature
Date: