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2. Form Must Be Complete in Full
3. Date
   Date
5. Project Information
7. Project Name
8. Tax ID Number
10. Building or Facility Name
12. Address
14. City Assigned Project Number
15. Type of Action
19. Owner Agent Information
21. Name
22. Company/Firm
24. Address
26. Phone Number
27. Fax Number
28. Email
32. Building or Facility Owner (Person or Entity That Holds Title to Property)
34. Name
35. Company/Firm
37. Address
39. Phone Number
40. Fax Number
41. Email
45. Owner’s Designated Agent

    If the owner chooses to designate an agent to act on the owner’s behalf, per §154.026(C)(3)(c) and 155.109(B)(2), the owner must do so in writing. The Owner Agent Designation Form must accompany the Application Form if an agent will be designated.

47. I, (owner's name)
48. designate
49. (agent's name)
51. as my agent in all responsibilities of ensuring compliance with the provisions of the Code of Wimberley for this project.
53. Owner's Name as Signature
54. Date
    Date
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56. 1. Receive an email copy of this form.
57. Email address

    This field is not part of the form submission.

58. Submit

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