Affidavit of Consent - signedNOTE: A statement of authority and/or written consent is required for all agents and/or applicants from the property
owner for all Village zoning and building applications. The property owner may sign each application, or may use this
form to grant consent to an agent and/or applicant to apply on their behalf.
AFFIDAVIT OF CONSENT
I, (print name), asjQ,Ni�
(title if applicable) ofif . (legal entity applicable)
swear or affirm that I _ am the owner f the property located at
Cotleur & Hearing, Alexander renholz
Minor Site Plan Modification
and give my consent to
to act as my Agent and to submit
of development application(s)) to the Village of North Palm Beach on my behalf.
STATE OF 0k
COUNTY OF
(type
The foregoing was sworn to (or affirmed) and su scribed before me on this the
day of %ei..r , 201 q , by g
who is personally known to me or who has produced (type of
identification) and w o id/did not take an oath.
(729C,f, ty
(si tore of ersontMng knowledgement)
OyU
(Name of offi&r taking acknowledgement — typed, printed or stamped)
SEAL
JOYCEMOREAU
.*; MY COMMISSION # GG 249760
EXPIRES: August 26, 2022
oR t 4••' Bonded Thru Notary Pu66e Undenv*W
THE VILLAGE OF NORTH PALM BEACH
COMMUNITY DEVELOPMENT DEPARTMENT
420 U.S. HWY 1 • SUITE 21 o NORTH PALM BEACH FLORIDA 33408
PHONE 561.841.3365 s FAX 561.841.8242 e WWW.VILLAGE-NPB.ORG
NOTE: A statement of authority and/or written consent is required for all agents and/or applicants from the property
owner for all Village zoning and building applications. The property owner may sign each application, or may use this
form to grant consent to an agent and/or applicant to apply on their behalf.
AFFIDAVIT OF CONSENT
I, (print name), asjQ,Ni�
(title if applicable) ofif . (legal entity applicable)
swear or affirm that I _ am the owner f the property located at
Cotleur & Hearing, Alexander renholz
Minor Site Plan Modification
and give my consent to
to act as my Agent and to submit
of development application(s)) to the Village of North Palm Beach on my behalf.
STATE OF 0k
COUNTY OF
(type
The foregoing was sworn to (or affirmed) and su scribed before me on this the
day of %ei..r , 201 q , by g
who is personally known to me or who has produced (type of
identification) and w o id/did not take an oath.
(729C,f, ty
(si tore of ersontMng knowledgement)
OyU
(Name of offi&r taking acknowledgement — typed, printed or stamped)
SEAL
JOYCEMOREAU
.*; MY COMMISSION # GG 249760
EXPIRES: August 26, 2022
oR t 4••' Bonded Thru Notary Pu66e Undenv*W