Owners Authorization Form.pdfEdmonds
Edmonds Register of
Historic Historic Places
Preservation
Commission
FOR OFFICE USE ONLY
Date Received:
Received by:
File #: i �,, t\,,, L,,) E
Survey/Site 4:
I /We the undersigned certify that we are the owners of the property identified located at:
as
give my/our consent to listing the
NAME: (Please printV
SIGNATURE:
NAME: (Please prinl) —Sh
SIGNATURE:
on the Edmonds Register of Historic Places.
and hereby
ONE #:- Z/ 7
Z1,
Z
DATE: 324'
DATE 1-2 a