20160961 Ver 1_Agent Authorization Letter_20161027

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. ':5- PLAN NO. PARCEL ID:
STREET ADDRESS: %l��- 1� r' t
NCI ho LC- 2- 5"7 5 2-
Please
Please print: Wok
t i�,
Property Owner: h 0�lrlS ��0�� �i� ✓� ��i i
Property Owner: M Ct KLA )Ajo ,c?m u4-4-1
The undersigned, registered property owners of the above noted property, do hereby authorize
D V( RfttlG'1 D1 , of 12 A nUlpk) 6t)Lf V�; �'
Name of�sultin firm
(Contractor/ Agent) ( 9 ) 7
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):
32 I U VVI r S_f Cr rC. C0 e fi d2�1�
Telephone:
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
orized ignature Authorized Sgnai
re
Date: �_r_� Z�l Date: / j Z�j