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Odom
#' Engineerft Puc
A) PROJECT INFORMATION
169 Oak Street • Forest City, NC 28043
office 828.247.4495 • fax 828.247A498
AGENT AUTHORIZATION FORM
PROJECT NAME: RUMBLING BALD -MARINA SEAWALL
PROJECT LOCATION: 172 QUAIL RIDGE BLVD
DEED BOOK/PAGE: 607/757
B) OWNER INFORMATION
PARCEL ID: 1618031
NAME: FAIRFIELD MOUNTAINS PROPERTY OWNERS
MAILING ADDRESS: 112 MOUNTAINS BLVD
LAKE LURE, NC 28746
PHONE: [phone]
C) AGENT INFORMATION
EMAIL: [e-mail]
NAME: DAVID ODOM ODOM ENGINEERING, PLLC
MAILING ADDRESS: 169 OAK ST. FOREST CITY, NC 28043
PHONE: [phone] EMAIL: [e-mail]
SIGNATURE: DATE: 4/24/2024
D) AUTHORIZATION
This is to authorize the above -named agent to act on my behalf and take all actions necessary for the processing,
issuance, and acceptance of all necessary permits/certifications for the proposed project.
I hereby certify the above information submitted in this Agent Authorization Form is true and accurate to the best
of my knowledge.
OWNER'S SIGNATURE: DATE: 0401