312 Courthouse Sq., Ste. 14
Bay Minette, AL 36507
1100 Fairhope Ave.
Fairhope, AL 36532
201 E. Section Ave.
Foley, AL 36535
Authorized Agent Form
I/We authorize and permit the authorized agent listed below to act as my/our representative and agent in any
manner regarding the issuance of a building permit which relates to property described as the tax parcel ID #
listed below.
I/We understand that the agent representation may include but not be limited to decisions relating to the
submittal, status, or conditions of this application. In understanding this, I/we release Baldwin County from any
liability resulting from actions made on my/our behalf by the authorized agent and representative. I hereby certify
that the information stated on and submitted with this application is true and correct. I also understand that the
submittal of incorrect information will result in the revocation of this application and any work performed will be
at the risk of the property owner/applicant. I understand further that any changes made which vary from the
approved plans will require obtaining an additional approval from the Building Official.
*NOTE: All correspondence will be sent to the authorized representative. It will be the representative's
responsibility to keep the owner(s) adequately informed as to the status of the application.
Parcel ID #: 0 5 - __ __ - __ __ - __ __ - __ - __ __ __ - __ __ __ . __ __ __
911 Property Address (include city): _____________________________________________________________
Authorized Agent
Printed Name: _____________________________
Mailing Address: ___________________________
Phone #:_________________________________
Email: ___________________________________
Signature: ________________________________
Property Owner
Printed Name: _____________________________
Mailing Address: ___________________________
Phone #:_________________________________
Email: ___________________________________
Signature: ________________________________
State Issued Photo ID
** attach if not having property owner signature notarized **
Attach a copy of the property owner’s state issued photo
ID (such as a drivers license) OR have a Notary Public
notarize the property owner’s signature on this form.
Property owner should initial inside this box
if he/she will attach a copy of the state issued
photo ID instead of having property owner
signature notarized.
Notary Public
** complete if not attaching a State Issued Photo ID **
State of ______________________________________
County of _____________________________________
Subscribed and sworn to before me this _______ day of
________________, _______ by the property owner
listed above.
Notary Signature: ______________________________
Notary Public’s Seal