The corporate representative will need to provide proof to Brevard County Public Works that
he/she is authorized to sign this document.
AUTHORIZATION TO ACT ON
BEHALF OF OWNER
(Corporation)
BREVARD COUNTY PUBLIC WORKS ENGINEERING
I, _______________________________________, the ___________________________ of
(Print Name) (Title)
________________________________, authorize _______________________________________________
(Name of Corporation) (Person and Company name)
to act on the Corporation’s behalf in the submittal of the attached development plan and/or
application with respect to __________________________________________________________________.
(Project Name)
Affix Corporate Seal ________________________________
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: _______________________________
