20240628 Ver 1_Agent Authorization_20240501

Please mate that multiple forms may he necessary if t)ere are more than two owners of the property,
PROPERTY LEGAL DESCRIPTION;
STREET ADDRESS OF EXIaT NG HOME or LATDUDE]L©NGITUDE QE NEW CONSTRUCTION:
rrJ2[11 Catawba Hickory NO 28601
�.3. F 72/-8 f .4G� —
1PrIDpe Owner Narre(s) -- please print"
Property Owner: Richard Edwardson
PrOPerty Owner. -
The undersigned, registered property Owners of the above rotetf property, do herebyalthorixe
Charlie Washburn
(coakractarJAgent}
of Marine Construction LLG
(Name of company)
to act ❑n my behaIf and take all actions necessary far the processing, issuance and arceptance of t#)is
perm;t or certification and any and all standard and special conditions attached.
Property Owners Mailing Address (if different than Prop" address above):
Same as Above
Praperty Owner(s) 'telephone: [phone]
We hereby certify that: the above infbrrnatpon submitted in this appiicatlan is true and accurate to the
best of our knowledge.
p......
or'WA Signaw _ T
Authorized Signature
bate _ w