HomeMy WebLinkAboutauthorization of representationDEPARTMENT OF PLANNING AND DEVELOPMENT
723 West Markham Street
Little Rock, Arkansas 72201-1334
Phone: (501) 371-4790 Fax:(501) 399-3435
www.littlerock.gov
CERTIFICATE OF APPROPRIATENESS
AUTHORIZATION OF REPRESENTATION STATEMENT
T + n yuC.Y Ilc't do hereby authorize
Property owner (pant
irn (1, nY tyb to represent me and my interests in an
en
Agbrepresentative name and business (print)
Application for a Certificate of Appropriateness on the following property described below. I
have reviewed the proposed application and I have indicated so by initialing a copy of the
submittals that are attached.
Street Address:
�I ► v Title Hold'er's Signature
gent's Signature
3 q
Date
-: Ze �� /—/ 7
ate
Subscribed and sworn to me, a Notary Public on this /n day of C� I
My Commission Expires: b & 16 J as
J.
r1jLIr,.
'COMM. EXP.-. p
6-1-2025
*:No. 12689850:
O'. PULASKI
.;A '• COUNTY '.Ci
Page 5 of 5 Revised 12/2/2016