2829 Minerva Lake Rd. Columbus, OH 43231     614-882-5743

www.minervapark.org            zoningofficer@minervapark.org

AUTHORIZATION TO VISIT PROPERTY-Must be completed by property owner-or representative as named below

By signing below, the signee authorizes Village representatives to visit, photograph and post notice(if applicable) on the property as described in this application

AGREEMENT TO COMPLY AS APPROVED-must be completed by property owner-or representative as named below

By signing below, the applicant agrees that the project will be completed as approved and any proposed changes to the approved plan shall be submitted for review and approval.

AUTHORIZATION FOR OWNER'S APPLICANT OR REPRESENTATIVE(s):if the applicant is not the property owner, this section must be signed.

By typing the representative's name in the box and signing below, the signee authorizes the representative to act on the signees behalf, and agrees to be bound by all terms and agreements made by the designated representative.