Fillable Owners Authorization City of Providence Department of Public (City of Providence)

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Owners Authorization City of Providence Department of Public (City of Providence)

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City of Providence
Department of Public Works
Owner’s Authorization
I, ____________________________________________, am the owner of property located at
______________________________________________________________________, in the
City of Providence,
Hereby authorize _____________________________________________________________
A (licensed plumber) (licensed drainlayer),
To act as my agent for the purpose of obtaining a building sewer permit for this property.
Furthermore, I hereby agree that I will do the work in accordance with the local laws,
ordinances, regulations and permits of the City as those local laws may apply to the particular
location or work, and will save the City and other parties from loss or damage claims of every
name and nature.
My mailing address is:
Signed by: Witnessed by:
______________________________ ______________________________
______________________________ ______________________________
Date Date
______________________________
Print Name
Print Form
700 Allens Avenue|Providence|Rhode Island 02905|(401)467-7950|Fax(401)941-2567
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Owners Authorization City of Providence Department of Public (City of Providence)

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Completed 24 January 2021

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