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i n uug ii- n i ii�wi wr�wii u `i iui�iisi�i��wi <br /> '^•�` ° RAN .InAOI IIN Rn1 INTY CIT <br /> nMMI INY nFVFI nPMFNT IIFPARTMFNT <br /> rrr r un. aan j <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> I, the OwiiedA aht a gee, to defend, Inderriiil <br /> g g , and h6ld harmless the County and Its agents, offlaeis and employees from any Galvin, <br /> action or proceeding against the Owner/Agent's project. <br /> I further certify, under penally of perjury, that I am(check one): <br /> ❑ Legal property owner(owner includes partner,trustee, grantor, or corporate officer) of the property(s) involved in this <br /> application, or <br /> ❑ Legal agent (attach proof of the owner's consent to the application of the property's involved in this application and have been <br /> authorized to file on their behalf.,and that the foregoing application statements are true and correct. <br /> Print Nameulac "�l w. f^ Signature: Date: <br /> Print Namery�N✓rn t t•ttr�ll,( Signature Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br />