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Building\Building Documents\Agent Authorization 2010 COUNTY OF ALPINE Community Development Building Department Tony Creter, Building Official 50 Diamond Valley Road, Markleeville, CA 96120 Phone: [PHONE REDACTED], Fax: [PHONE REDACTED] www.alpinecountyca.gov/building_department AUTHORIZATION OF AGENT TO ACT ON PERMIT APPLICANT’S BEHALF I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain a Building Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: Phone Number of Authorized Agent: _ I declare under penalty of perjury that I am the permit applicant for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the permit applicant’s driver’s license, form of notarization, or other verification acceptable to the agency may be required to be presented when the permit is issued to verify the permit applicant’s signature. Permit Applicant’s Signature: Date: