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UP1SA/IP <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 1,the Owner/Agent agree, to defend,indemnify,and hold harmless the County and its agents, officers and employees from any <br /> claim,action or proceeding against the Owner/Agent's project. <br /> 1,further, certify under penalty of perjury that/am(check one): <br /> Legal property owner(owner includes partner,trustee,trustor,or corporate officer)of the property(s) <br /> involved in this application, or <br /> ❑ Legal agent(attach proof of the owner's consent to the application of the property's involved in this <br /> application and have been authorized to file on their behalf) <br /> and that the foregoing application statements are true and correct. <br /> Print Name: '�Ia Y-S E'y`- Signature: Date: I Z/c//�' <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Mountain HouselMH Application FormSIMH-UP-SA-IP form-MASTER.doc <br /> -R- <br />