Laserfiche WebLink
.05/30/2002 09: 04 209-9F' '509CENTURY 21 COLLI-" PAGE 02 <br /> •�-•�-•a%-A"4 28, 34 0102 <br /> APPLICATION . SITE APPROVAL <br /> 7� ,; <br /> UTHOR/ZAT/pN SIGNATURES <br /> Y TNd O WNER OR TH6 PROPER R AN AU77fOR/iEp gQEM MAY <br /> reNAgent a .ee, ✓c1LRAN APPUCA ON. <br /> s from an 9 ro deter o And* <br /> NL <br /> end hold herinleas the County and Its sgenh, ow,ws and <br /> Y claim, rctfon orprvicevo'!ng apa/nst the Owner/Agent's project <br /> certify under penalty of perjury thatfem(cher*one).property owner(owner lncladva partner, Iruatve, trustor, or corpora2a of//cvq ofthen rhis epplicatlGn, or property(s�agent(attach prop/of[hv owner s consent to the applieatlon of the prQperfy'a/nvolvvtl in fhla <br /> rn and have.Sven auihorf:ed to/110 on their bahrH,, and that the farvgotng appficadon statements <br /> aro true and correct, <br /> Pr/nt Neme: <br /> �+—=.+C-6tLLt� A/ynaluryl � Deh; x'30-Ox <br /> Print Name: <br /> Data: <br /> Print Name: <br /> Data: <br /> Q Print Namr: <br /> N •Npnsturv; <br /> Da h: <br /> Print Nama: <br /> Signature: <br /> Date: <br />