20181124 Ver 1_Agent Authorization_20180813

AGENT AUTHORIZATION FORM
Property Legal Description:
Parcel ID: ___________________________ Deed Book and Page: ____________________________
Address: ____________________________________________________________________
Property Owner(s): ________________________________________________________________
Phone Number: ____________________________________
The undersigned, registered property owner(s) of the above noted property, do hereby
authorize
Greg Jennings of Jennings Environmental LLC
Agent Business Name
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):
_______________________________________________________________________________________________________
We hereby certify that the above information submitted in this application is true and
accurate to the best of our knowledge.
____________________________________________ ____________________________________________
Authorized Signature Authorized Signature
____________________________________________ ____________________________________________
Date Date
2805 Par Drive Raleigh, NC 27603
The Greens at Tryon, LLC
240-395-2000
5425 Wisconsin Ave Suite 202 Chevy Chase, MD 20815
16787 Pg 803-815