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Get TX TDLR 043AB 2012

Owner s Signature TDLR FORM 043AB 08-12 NOTE Date An individual who completes and files this form with the Texas Department of Licensing and Regulation the Dept. TEXAS DEPARTMENT OF LICENSING AND REGULATION COMPLIANCE DIVISION - ARCHITECTURAL BARRIERS P. O. Box 12157 Austin Texas 78711 512 539-5669 877 278-0999 FAX 512 539-5690 architectural*barriers license. state. tx. us www. license. state. tx. us OWNER AGENT DESIGNATION In accordance with the Texas Department of Licensing and Regulation s TDLR Administrative Rule 68. 10 9 individuals designated to act on the owner s behalf must be designated in writing. FORM MUST BE COMPLETED IN FULL PLEASE PRINT OR TYPE Project Information 1. Project Name 2. EABPRJ 3. Building or Facility Name 4. Address Suite City Zip Owner Agent Information 5. Name 6. Company/Firm 8. Phone 9. Fax State 10. Email 11. Name 14. Phone 15. Fax Owner s Designated Agent If the owner chooses to designate an agent to act on the owner s behalf per 16 Texas Administrative Code Chapter 68 Architectural Barriers Administrative Rule 68. 10 9 the owner must do so in writing. The Owner Agent Designation Form must accompany the Project Registration Form and/or Request for Inspection Form if an agent will be designated* I designate as my agent Owner Print Agent Print in all responsibilities of ensuring compliance with the provisions of the Texas Architectural Barriers Act Texas Government Code Chapter 469. is entitled to the following 1 to be informed about the information that the Dept. collects about the individual upon their request and subject to a few exceptions 2 to receive and review the information under Sections 552. 021 and 552. 023 of the Texas Govt* Code and 3 have the Dept. t correct information about the individual that is incorrect under Section 559. 004 of the Texas Govt* Code. The Department will add your address to the Architectural Barriers email notification list which automatically provides Department information on matters affecting Architectural Barriers. Your email address is confidential pursuant to the Texas Public Information Act the Department will not share it with the public* For additional information link to http //www. TEXAS DEPARTMENT OF LICENSING AND REGULATION COMPLIANCE DIVISION - ARCHITECTURAL BARRIERS P. O. Box 12157 Austin Texas 78711 512 539-5669 877 278-0999 FAX 512 539-5690 architectural*barriers license. state. tx. us www. license. state. tx. us OWNER AGENT DESIGNATION In accordance with the Texas Department of Licensing and Regulation s TDLR Administrative Rule 68. state. tx. us www. license. state. tx. us OWNER AGENT DESIGNATION In accordance with the Texas Department of Licensing and Regulation s TDLR Administrative Rule 68. 10 9 individuals designated to act on the owner s behalf must be designated in writing. FORM MUST BE COMPLETED IN FULL PLEASE PRINT OR TYPE Project Information 1. 10 9 individuals designated to act on the owner s behalf must be designated in writing. FORM MUST BE COMPLETED IN FULL PLEASE PRINT OR TYPE Project Information 1. Project Name 2. EABPRJ 3. Building or Facility Name 4. Address Suite City Zip Owner Agent Information 5. .

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