HomeMy WebLinkAboutsigned COA 11-2-2012DEPARTMENT OF PLANNING AND DEVELOPMENT
723 West Markham Street
Little Rock, Arkansas 72201-1334
Phone: (501) 371-4790 Fax: (501) 399-3435
CERTIFICATE OF APPROPRIATENESS
AUTHORIZATION OF REPRESENTATION STATEMENT
I, eof 44 01644 &4 qJw- zr &ZAL - &,Q do hereby authorize
Property owner (pnny
"� Kt �t4wS ee�.� e>E� to represent me and my interests in an
A ent/representat� a 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:
SM L.✓ It pqy + Srnses ( YGVDw �D�
^�e Holder's Signature
���(�/,) Agent's Signature
Subscribed and sworn to me, a Notary Public on this
My Commission Expires:
Date
- 1/--2- /z.
Date
day of ,
Notary Public
Revised 8/2012