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DEPARTMENT OF PLANNING AND BUILDING <br /> * 1$ yl DEPARTMENT OF PUBLIC HEALTH AND ENVIRONNMENT <br /> 1555 NORTH 17TH AVENUE <br /> GREELEY, CO 80631 <br /> G0 l <br /> AUTHORIZATION FORM <br /> I, (We), Varra Companies, Inc. , give permission to Westervelt Ecological Service <br /> (Owner—please print) (Authorized Agent—please print) <br /> to apply for any Planning, Building or Septic permits on our behalf, for the property located at (address or <br /> parcel number) below: <br /> Parcel#: 09593400006 <br /> Legal Description: South 1/2 of Section 34 Township 5 N, Range 66 <br /> W Subdivision Name: Lot <br /> Block Property Owners Information: <br /> Address: 8120 Gage Street Erie, CO. 80516 <br /> Phone: 303-666-6657 E-mail: gvarra(a_varracom pan ies.com <br /> Authorized Agent Contact Information: <br /> Address: 7345 S. Alton Way, Unit 9D, Centennial, CO. 80112 <br /> Phone: 720-955-3029 E-Mail: Iharrington(o).westervelt.com <br /> Correspondence to be sent to: Owner Authorized Agent Both X / by Mail Email X <br /> Additional <br /> Info: <br /> Owner Signature: !/ Date: <br /> i <br /> Owner Signature: Date: <br />