HomeMy WebLinkAboutHDC2015-033 Certificate Of Appropriateness 10/09/2015M
DEPARTMENT 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
A, IF, 1C.A
Property owner
do hereby authorize
1')NAVC,
to represent me and my interests in an
Agent1representative 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:
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Title Holder's Signature
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Date
Agent's Signature Date
Subscribed and sworn to me, a Notary Public on this day of , (�Oe?1� .
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My Commission Expires: j f ,
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N ary Public
Revised 8/2012