City of Washington
Department of Planning and Development
Application for a Special Use Permit

Page 5: Owner Authorization for Non-Owner Application
NOTE:
IF THE PERSON WHO IS REQUESTING THE BOARD OF ADJUSTMENT TO TAKE ACTION ON A PARTICULAR PIECE OF PROPERTY IS NOT THE OWNER OF THE PROPERTY OR DOES NOT HAVE A BINDING OPTION TO PURCHASE THE PROPERTY, THEN THE ACTUAL OWNER OF THE LAND MUST COMPLETE THIS FORM.
IF THE PERSON WHO IS REQUESTING THE BOARD OF ADJUSTMENT TO TAKE ACTION ON A PARTICULAR PIECE OF PROPERTY IS THE OWNER OF THE PROPERTY OR HAS A BINDING OPTION TO PURCHASE THE PROPERTY, PLEASE DISREGARD THIS FORM.

Dear Sir or Madam,

I am the owner of the property located at:

I hereby authorize:
to appear with my consent before the City of Washington Board of Adjustment in order to ask for a special use permit to:
 
at this location.  I understand that the special use permit, if granted, is permanent and runs with the land.  I authorize you to advertise and present this matter in my name as the owner of the property.
If there are any questions, you may contact me at my address:
 
or by telephone at:_________________________________.

Respectfully yours,

_______________________________________________
Owner

 

Sworn to and ascribed before me, this the________day of_________, 20___.

_______________________________________________
Notary Public

My commission expires:_____________________________

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