Laserfiche WebLink
r <br /> Mar 07 03 12: 35p EHOLEY !. RSSOCIRTES, INC IE 786-3729 p. 7 <br /> APPLICATION _ CITP A aoon I`A I <br /> AUTHORIZATION SIGNATURES <br /> ONLYTHE.'OWNERjOFTHEPRO'pER7y'ORAN-AUTNOPJZEDAGENT MAY FILE AN APPLICATION. <br /> 1, the Owner/Agent agree,to ddand,hrdamrl <br /> employees from IrY.and hold harmless the County and Its agents, officers and <br /> any Scope Or Proceadlny egalnst the OwrrerrA <br /> gents pro/act <br /> 1, further, certffy under pen&HY of perjury that l am(check one): <br /> O Legal property owner(owrwIncludes partner, trustee, trustor,or corporate officer) of the property(sj <br /> Involved In this applleat/on,or <br /> D Legal agent(attach proof of(1118 oumer's corpent to the application of the property's Involved In thfs, <br /> i ep:--1lcai'c..and hese bran a therhed to t!!6.cr.;;,v;;�ahalf.,and that <br /> the foregoing applfcaSo»statamnu_; <br /> N era tnre and rorroct. <br /> ' r n <br /> Print Name: J� ' 1-n ,��Y' - 3 <br /> 1 ' /,^ Signature. � � 111 alfa:(J_;'jtl'-L'„ <br /> 131nt Name: Signa /'..: I(�. C-C./l C�l�( <br /> n� Data: E C.3 <br /> Pnnt Name- (-0/ <br /> a.ta: iv u <br /> Print Name: <br /> Signature: <br /> Data. <br /> IMnr�'reM.! erynaern,r <br /> Danr <br />