20051216 Ver 4_Agent Authorization Form_20190621

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
AUTHORIZING PARTY 1: L'Qst raocey Woe,, ana <ww 5tei- -
6-,iiy 6-eA.,ser /doom // &,vdsvrrre/ ,JC 28714 828 -(*2z-597/
AUTHORIZING PARTY 2:""fit
PD x 97� ws-w-ne, )JG Za7W -021-&82'24/20
The undersigned, registered property owners of the above noted property, do hereby authorize
kandy `71.4 *z of W"#heyS /Cavene/
(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.
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Signature Authorized Signature
W' u
Date: W2401 19
Date: !`�"