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s <br /> APPLICATION - <br /> ACITH�RIZATf�ISi SIGNATURES:`. <br /> ONLY THE.OWNER OF THE PROPERTY.OR`AN.AIJTHOR1ZI~I].AGENTMAY`FiLEAI APpt 1CATfpiV. <br /> 1, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and employees <br /> from any claim, action or proceeding against the Owner/Agent's project. i <br /> 1, further, certify under penalty of perjury that i am (check one): Y <br /> 0 Legal property owner'(owner includes partner,trustee,trustor, or corporate officer) of the <br /> property(s) involved in this application, or <br /> ❑ Legal agent(attach proof of the owner's consent to the application of the property's involved <br /> in this application and have been authorized to file on their behalf.,and that the foregoing <br /> application statements are true and correct. <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: r — <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> l <br /> i <br />