HomeMy WebLinkAbout*Other - BuildingGrant County
Department of Building/Fire Marshal
POBox 37
Ephrata WA 98823
(509) 754-2011 ext. 3001
BUILDING PERMIT ACTIVITY - AUTHORIZATION FORM
As legal owner(s) of Parcel 1 Z - 0 (v 4 3 - 0 6 a, I acknowledge and approve the request for
Building Permit(s) for construction or installation of the specific structures / work listed below:
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Further, I hereby authorize the following person(s) to act as my agent(s) regarding any activities
involving the Application, and subsequent Permit, as noted above and filed with Grant County:
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Name
Company
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to Owner
Name Company Relationship to Owner
Name — Company Relationship to Owner
(For relationship to owner, be specific such as agent, contractor, tenant, co-owner, purchasing land, etc)
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Legal Own71
u / ,poral ent ive ignature
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Date
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Printed
t Printed Name L
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Title and I Company Name
Legal Owner Signature / Corporate R t
resentative Signature
Date
ov-
Printed Name
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Title and Coml3any Name
As landowner, building owner and applicant for a Building Permit, if you want someone
other than yourself to act as your agent, including contractors engineers architects, etc.,
you must complete this form and submit with each applicable application.
In cases of co -ownership, all legal owners must sign the form or attach additional forms.
Corporations and Trusts must have signature by at least one governing member or agent authorized
to bind the corporation or trust.
This form may also be used for Tenants or other parties to authorize agents on their behalf.
2/13/2017