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1, the UwnerlAgent agree, to oereno, indemnity, ana nota narmtess the county and its agents, officers and employees <br /> from a.iy claim, action or proceeding against the Owner/Agent's project. <br /> _r. <br /> 1, further, certify under penalty of perjury that I 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 owner of the property(s) <br /> involved in this application and have been authorized to file on their behalf, and that the foregoing <br /> application statements are true and correct to the best of my knowledge and belief. <br /> Print Name: Jeff Kjeldsen Signature: as<_1 Date: 11/30/2000 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br />