HomeMy Public PortalAboutAgent For Owner AuthorizationAGENT FOR OWNER AUTHORIZATION FORM
THIS FORM SHOULD BE USED WHEN THE PERMIT APPLICATION WILL BE EXECUTED OR SUBMITTED BY A PERSON OTHER THAN THE
PROPERTY OWNER. THE FOLLOWING SHALL BE COMPLETED AND SIGNED BY THE PROPERTY OWNER AND RETURNED TO THE
BREWSTER BUILDING DEPARTMENT WITH THE PERMIT APPLICATION.
AS THE OWNER OF: ________________________________________________________________________________________________,
(JOB LOCATION)
I HEARBY AUTHORIZE: _____________________________________________________________________________________________
(PRINT INDIVIDUAL NAME, AND COMPANY NAME IF APPPLICABLE)
TO BE MY AUTHORIZED AGENT, TO ACT ON MY BEHALF AND REPRESENT ME IN ALL MATTERS REGARDING
WORK AT THE ABOVE-MENTIONED PROPERTY AS PERMITTED AND REGULATED BY THE BREWSTER BUILDING
DEPARTMENT. SAID PERMISSION INCLUDES, BUT IS NOT LIMITED TO, ACQUIRING ALL REQUIRED PERMITS
AND PERFORMING ALL WORK REQUIRED AT THIS LOCATION.
___________________________________________________________
(OWNER’S PRINTED NAME)
____________________________________________________________ ___________________________________
(OWNER’S SIGNATURE) (DATE)
BBD Agent Authorization Form 1/10/2022