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ONLY THE OWNER OF THE PROPERTY OR AN II4ZTH0PJZED AGENT MAY FO <br /> LE M APPL1CATa®Ri. <br /> I, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and <br /> employees from any claim, action or proceeding against the Owner/Agent's project. <br /> 1, further, certify under penalty of perjury that 1 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., and that the foregoing application statements <br /> are true and correct_ <br /> Print Name: C ' l" � cwd <br /> —//�� --1 � . Signature: :.�, Date: 49 <br /> Print Name: R613,FR } :fit �� Signature: <br /> Date: <br /> Print Name: <br /> Signature: Date:_ <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br />