Form No.: RC-10 I, A Duly Licensed Professional Engineer or Registered Architect with an office at do herewith submit plans for a revocable consent for at Location Signature New York State License Number Telephone Number Seal Authorization of Petitioner I, . hereby authorize the above named party to submit the above noted plans pursuant to my application for a revocable consent. Signature Date American LegalNet, Inc. www.FormsWorkFlow.com