Fillable AUTHORIZATION TO ACT ON BEHALF OF OWNER (Brevard County Board of Commissioners)

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AUTHORIZATION TO ACT ON BEHALF OF OWNER (Brevard County Board of Commissioners)

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AUTHORIZATION TO ACT ON
BEHALF OF OWNER
BREVARD COUNTY PUBLIC WORKS ENGINEERING
I, _____________________________, being the owner of _______________________________________
(Print Name) (Project Name)
authorize _____________________________________________ to act on my behalf in the submittal of the
(Person and Company Name)
attached development plan.
__________________________________________ ____________________________________
Signature Title
State of ____________________
County of ____________________
The foregoing instrument was acknowledged before me by means of physical presence or online
notarization, on this _____ day of ___________________, 20____, by ___________________________
who is personally known to me or who did produce ___________________________________________
as identification.
Notary Public Signature: _____________________________
Notary Public, State of: _____________________________
My Commission Expires: _____________________________
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AUTHORIZATION TO ACT ON BEHALF OF OWNER (Brevard County Board of Commissioners)

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Completed 1 April 2021

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