TOWN OF NORTH EAST
19 N Maple Avenue, PO Box 516, Millerton, NY 12546
P 518-789-3300 x606, F 518-789-3399
ne.buildingdept@taconic.net
I:\BUILDING DEPT TEMPLATES\Owner's Endorsement.docx (revised 7/2019)
PROPERTY OWNER’S ENDORSEMENT
(To be completed if person applying for permit is not the property owner)
State of New York
County of _________________
I hereby certify that I ________________________________ am the Homeowner/Owner in fee
(Name)
of property at ____________________________________________ in the Town of North East.
(Address)
I hereby authorize _______________________________ of _____________________________
(Agent) (Company)
to make application for a permit to perform said work in the foregoing application.
_____________________________ _______________
Owner in Fee Date
I __________________________________ being duly sworn, affirm that I am a representative
(Agent)
of ______________________________________ and am authorized by the owner to obtain
(Company)
permits and perform said work in the foregoing application and plans and that all statements
contained therein are true to my knowledge.
____________________________________
Signature of Applicant/Agent
Sworn to before me this __________ day of __________________, 20_________.
____________________________________
Notary Public
click to sign
signature
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