20190691 Ver 1_Agent Authorization Form_20190712

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SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LDGAL DESCRIPTION:
16:39:03 07-11-2019
LOT NO. PLAN NO, PARCEL ID:
STREET ADDRESS: 105 Car®ee\jer 1Z�3 OiEail�r
Please print:
Property -
Property
No. 3367 P. 2
The undersigned, registered property owners of the above noted property, do hereby authorize
N. �ran;nc,lrhaC�roe<
(Contractor /Agent) (Name of corls{1lting 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):
Telephone:
We hereby celitfy the above Information submitted in chis application is true and accurate to the
best of our knowledge,
Date:
zed re