20181711 Ver 1_Agent Authorization Letter_20181214

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
PARCEL NAME/LOT NO. EVANS PARK PARCEL ID: 29000
STREET ADDRESS: 625 West Arlington Boulevard
Please print:
Property Owner: City of Greenville
Property Owner: Contact Public Works
The undersigned, registered property owners of the above noted property, do hereby authorize
Todd Tripp & Michelle Clements , of The East Group
(Contractor / 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 Owner's Address (if different than property above):
1500 Beatty Street, Greenville, NC 27834
Telephone: (252) 329 - 4683
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
A ori d Signature Authorized Signature
Date: �� I � [J Date: