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Building - Permit Authorization Request

  1. to pick up permits and sign any documents related to:

  2. Please choose one of the following:

  3. Qualifiers Signature_______________________________________________

  4. The forgoing authorization letter was acknowledged before me this ___________ day of ________, 20____by____________________________


    ___who is personally known to me
    ___who has produced identification_________________________________________


    Notary Public Signature:______________________________________

    My Commission Expires ______________________________________

  5. Please be advised this form is for customer use only. Building Services will not track, monitor or receive a copy of this request. Enter a valid email below to receive a copy for your processing.

  6. Leave This Blank:

  7. This field is not part of the form submission.