Letter Of Authorization Template- Teton County printable pdf download

LETTER OF AUTHORIZATION

______________________________________________, “Owner” whose address is: _______________

____________________________________________________________________________________,

as owner of property more specifically described as: __________________________________________

________________________________________________________________________________,

hereby authorizes _______________________________________________________ as agent to

represent and act for Owner in making application for and receiving and accepting on Owner’s behalf,

any permits or other action by the Teton County Commissioners, the Teton County Planning and

Development, Building, and/or Engineering Departments relating to the modification, development,

planning, platting, replatting, improvements, use or occupancy of land in Teton County. Owner agrees

that Owner is, or shall be deemed conclusively to be, fully aware of and to have authorized and/or made

any and all representations or promises contained in said application of any Owner information in support

thereof, and shall be deemed to be aware of and to have authorized any subsequent revisions, corrections

or modifications to such materials. Owner acknowledges and agrees that Owner shall be bound and shall

abide by the written terms or conditions of issuance of any such named representative, whether actually

delivered to Owner or not. Owner agrees that no modification, development, platting or replatting,

improvement, occupancy or use of any structure or land involved in the application shall take place until

approved by the appropriate official of Teton County, in accordance with applicable codes and

regulations.

Owner agrees to pay any fines and be liable for any other penalties arising out of the failure to

comply with the terms of any permit or arising out of any violation of the applicable laws, codes or

regulations applicable to the action sought to be permitted by the application authorized herein.

Under penalty of perjury, the undersigned swears that the foregoing is true and, if signing on

behalf of a corporation, partnership, limited liability company or other entity, the undersigned swears that

this authorization is given with the appropriate approval of such entity, if required.

__________________________________

_______________________________________

(Signature of Owner)

(Signature of Co-Owner)

__________________________________

_____________________________________

Title:

(Secretary or Corporate Owner)

ACKNOWLEDGMENT

State of ________________________

County of ______________________

The foregoing instrument was acknowledged before me this ________ day of ______________, 20____,

by _________________________________ (name of acknowledging agent), on behalf

of _________________________________ (Owner).

WITNESS my hand and official seal.

_____________________________________

Notary Public Signature

My Commission Expires: __________________

(This form may be faxed)

Letter Of Authorization Template- Teton County