HomeMy WebLinkAboutWigod Medical Clinic
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MAYOR
Tammy de Weerd
clferldi~n
IDAHO
CITY HALL
(208) 888-4433 - Fax 887-4813
PUBLIC WORKS
BlJILDING DEPARTMENT
(208) 887-2211 - Fax 898-9551
CITY COUNCIL MEMBERS
Keith Bird
Christine Donnell
Shaull Wardle
CharlesM.RounITee
LEGAL DEPARTMENT
(208) 898-5506 - Fax 884-8423
CERTIFICATE OF ZONING COMPLIANCE*
Date: October 19.2005
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Project Name: Wigod Medical Clinic
Owners: Mark Wigod
Site Address:
Amended Lot 2 Block 2 of Meadow lake Subdivision
Proposed Use: 4.600 square foot office/clinic/medical building
Zoning: L-O (limited Office) Planned Development
Comments:
Conditions of Approval:
Project is subject to all cun-ent Meridian City Unified Development Code (UDC)and conditions of
approval for the Touchmark/Meadowlalœ Subdivision. The issuance of this permit does not release
the applicant from any requirements ofthe approved Meadowlake Subdivision Conceptual Planned
Development, the Wigod Medical Office Conditional Use Permit (CUP-05-043) and the subsequent
Development Agreement. The property is located in a L-O Commercial zone where Clinics
(medical, dental, and optical) are permitted.
Landscaping: The Landscape Plan prepared by South Landscape Architecture PC. on September 14,
2005, Sheet L1.0, is approved (stamped "Approved" on October 19,2005 by the Meridian Planning
& Zoning Department) with no changes. The approved landscape plan is not to be altered without
prior written approval of the Planning & Zoning Department. No field changes to landscape plan
permitted; prior written approval of all material changes is required.
Upon complete build out of the site the developer shall install approved trees within the pro?osed
planters in accordance with UDC 11-3B. The approved landscape plan is not to be altered without
prior written approval of the Planning & Zoning Department. No field changes to landscape plan
permitted; prior written approval of all material changes is required.
Site Plan: The Site Plan labeled A-I.l, prepared by ZGA Architects on September 14, 2005, is
approved (stamped "Approved" on October 19, 2005 by the Meridian Planning & Zoning
Department): The approved site plan is not to be altered without prior written approval of the
PLANNING AND ZONING DEPARTMENT
660 E. WATERTOWERLANE, STE. 202, MERIDIAN, IDAHO 83642
(208) 884-5533 - Fax 888-6854
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Planning & Zoning Department. NOTE: the required Fire Department approval could require
changes to the approved site plan. If changes are made a new site plan must be approved by the
Planning Department.
lITigation: An underground, pressurized irrigation system must be installed to all landscape areas per
the approved specifications and in accordance with UDC 11-3A-15.
Curbing: Per UDC 11- 3B-51, all landscape areas adjacent to driveways, parking lots, or other vehicle
use areas, must be protected by curbing, wheel stops, or other approved protective devices. Curbing
may be cut to allow for storm water runoff.
Protection of Existing Trees: Any existing trees on site must be protected in accordance with the
Tree Preservation section of the City's Landscape Ordinance. Per UDC 11-3B-10, coordinate with
the Parks Department Arborist (Elroy Huff) for approval of protection measures prior to
construction. Any severely damaged tree must be replaced in compliance with UDC 11-3B-1 0-C.5.
Parking: The parking area shall be paved and striped in accordance with UDC 11-3B. Project
engineer/architect shall certify that the number and size of handicap-accessible spaces conforms to
the Americans with Disabilities Act (ADA). Handicap accessible stalls must have signage in
accordance per ADA and signed "Van Accessible". The site plan indicates 11 parking stalls and 2
handicap stalls along the front building line. UDC 11-3C-2 requires one space per 500 square feet in
commercial districts. Staff is reviewing the building at 4,600 sq/ft of commercial use. 4600/500 =
10 required stalls. The applicant has proposed the entire perimeter parking stalls to be 18'6"x 9'
which are not shown as compact as the front overhang will be in vegetated areas. Also, there are two
parking stalls and the two handicapped stalls which do not overhang the sidewalk accessing the
building and additional sidewalk width is not required.
The applicants engineer shall certifY that all drive aisles meet the minimum standards of the
Meridian Fire Department for turning radiuses. An 8.5 x 11 site plan stamped approved by the
Meridian Fire Department shall be submitted prior to construction.
Sidewalks: All sidewalks shall be constructed in accordance with 11-3A-17. Sidewalks shall be
constructed prior to occupancy.
Drainage: Storm water drainage swales shall not have a slope steeper than 3: 1, shall be fully
vegetated, and shall be designed in compliance with UDC 11-3B-11 and UDC 11-3A-18.
Fencing: Any required or proposed fencing shall be installed with current fencing standards as
defined in UDC 11-3A-7
Lighting: Lighting shall not cause glare or impact the traveling public or neighboring development
and comply with lighting standards as defined in UDC 11-3A-11
Signage: No signs are approved with this CZc. All signs will require a separate sign permit in
compliance with UDC II-3D.
Trash Enclosure: Any dumpster(s) must be screened in accordance with UDC-11-3A-12. Trash
enclosures must be built in the location and to the size approved by SSC.
Handicap-Accessibility: The structure, site improvements and parking must be in compliance with
all federal handicap-accessibility requirements.
PLANNING AND ZONING DEPARTMENT
660 E. WATERTOWER LANE, STE. 202, MERIDIAN, IDAHO 83642
(208) 884-5533 - Fax 888-6854
ACHD Acceptance: All impact fees, if any, shall be paid prior to the issuance of a building permit.
If any changes must be made to the site plan to accommodate the ACHD requirements, a new site
plan shall be submitted to the City of Meridian Planning and Zoning staff for approval prior to the
issuance of a building permit.
Certificate of Occupancy: All required improvements must be complete prior to obtaining a
Certificate of Occupancy. A Temporary Certificate of Occupancy may be obtained by providing
surety to the City in the form of a Letter of Credit or cash in the amount of 110% of the cost of the
remaining improvements. A bid must accompany any request for Temporary Occupancy.
Plan Modifications: The approved Site Plan and Landscape Plan stamped "Approved" on October
19, 2005 and are not to be altered without prior written approval of the Planning & Zoning
Department. No significant field changes to the site or landscape plans are permitted; prior written
approval of all changes is required.
~~~~
oseph R. Guenther
Associate City Planner
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*This letter does not indicate compliance with requirements of other departments/agencies, including, but not limited
to, Ada County Highway District, Central District Health Department, affected irrigation district(s), Meridian Sewer,
Water, Building or Fire Departments, Sanitary Services Co., etc. This letter shall expire one (1) year from the date
of issuance if work has not begun.
PLANNING AND ZONING DEPARTMENT
660 E. WATERTOWERLANE, STE. 202, MERIDIAN, IDAHO 83642
(208) 884-5533 - Fax 888-6854
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PROmCT NAME: "ÇK. H...-F; UJ j od C 1-. >1/ £- ( 1'1.5 r ~O~
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PHONE: ~5- éJ67Z. FAX:.:2ß- 7/ (Pl-. E-MAIL: ~Ic. f?) Z¿"",o CA>:'" ~~"t
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CITY OF MERIDIAN
Planning & Zoning Department
660 E. Watertower Ln., Ste. 202, Meridian, ill 83642
(208)884-5533 Phone / (208)888-6854 Fax
(Section 11-19-1, Zoning and Development Ordinance)
OWNER(S) OF RECORD:
ADDRESS: ~ 7 5r:::>
PHONE: 377- ¡51!?
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FAX:
E-MAIL: rr1^y'/::.dJUJ~.{. ¿'o~
ARCHITECT (IF DIFFERENT THAN APPLICANT):
ADDRESS:
PHONE:
FAX:
E-MAIL
ADDRESS, GENERAL LOCATION OF SITE:
TOWNSHIP, RANGE, AND SECTION:~/U:>Þ" Ire I "";Wr14,.IP 3 JJ. ~~"'j¿ ~e.~"-
f!!:,e".u.. /l1t'~ldl6( "'-
DESCRIPTION OF USE: ?r'l/~+e. )-/(oitCI\.l- ?,,- ~d-",e A--C( A~
PRESENT ZONE CLASSIFICATION: L--O
I, AI' WI dlC , do hereby affinn that I will agree to pay any additional sewer, water or trash
fees or charges, if an , associated with the use that I/we have applied for, whether the use be residential, commercial
or industrial in nature. Furthennore, I have read the infonnation contained herein and certify that the infonnation is
true and correct.
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(Date)
Rev, 1 ]/{)3/03
Plastic and
Reconstructive
Surgery
Cosmetic
Surgery
Hand Surgery
Diplomate
American Board
of Plastic Surgery
Diplomate
American Board
of Surgery
Fellowship Trained
Hand Surgery
Mark D. Wigod,MD,PA
8756 W. Emerald St.
Suite 186
Boise, Idaho 83704
Tel: (208) 3779515
Fax: (208) 377 9517
www. W!Jol. com
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Member
AMERICAN SOCIETY OF
PLASTIC SURGEONS
To whom it may concern,
This letter is to detail the proposed use of land purchased from Touchmark
by Wigod Properties, LLC.
I am a solo Plastic Surgeon. I plan to build a building for the use of my
private practice, as well as any future partners I may have. The building
will be approximately 4500 square feet on approximately 21,000 square
feet of land. Inside will be facilities for a clinic, ambulatory surgical suite,
and aesthetician services. These proposed uses have been reviewed by
Touchmark and St. Lukes Medical Center and neither party has any
objections.
I would be happy to provide more detailed explanations ifrequired.
Sincerely,
/}ÞJ- k- '"
Mark D. Wigod, MD, F ACS
----
CITY OF MERIDIAN
Planning & Zoning Department
660 E. Watertower Ln., Ste. 202, Meridian, ID 83642
(208)884-5533 Phone / (208)888-6854 Fax
CFRTIFTC'.ÁTF. OF ZONTNr. COMPT.TÁNCF, (CZC) ÁPPT.TCÁTION
(Section 11 ~ 19-1, Zoning and Development Ordinance)
PRomCT NAME: -.P, ..
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APPLICANT: 'Z'c."A. A"Gk+érc...+s; ?L.~"UC~"'...s
ADDRESS: s;r;ç ¿c.;.. ~1"t'-t' q.,t!'h <.AJ1. .t::. ~'Zç- ~/~~
PHONE: '3 '1'}-/!,i)7¡:'" FAX: :s '-f7:,-7/~2- E-MAIL: ~ ~,.,,:. tP~~.G"~
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OWNER(S) OF RECORD: :r-ou"k.""'~ ~ (iF
ADDRESS: :1ß"~ E. FrA"",éL.a. """" iZc:(..
PHONE: ð~ -Z~77 FAX: ÕÔÓ ,.6ÇJ¡
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E-MAIL: ~1JA.eJ1;I~1 L. (;6""'1
ARCHITECT (IF DIFFERENT 1HAN APPLICANT):
ADDRESS:
PHONE:
FAX:
E-MAIL
, ADDRESS, GENERAL LOCATION OF SITE: ~ J-o&,JÞ/~t!' d,..",~ (~(Q-iU ht:.e.
TOWNSHIP,RANGE,ANDSECTION:~~t:J/o"", 1(0. 7iJ~"5J,,p ~%.
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DESCRIPTIONOFUSE:~ 7r~t:.,¡"t:tf!Þ J C i-4", £ " ~
PRESENT ZONE CLASSIFICATION: J--O
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I, , ,do hereby affinn that I will agree to pay any additional sewer, water o~,tfå:sh '
fees or charges, if any, associated with the use that I!we have applied for, whether the use be residential,cqriimercia1',
or ipdustriaI in nature: Furthennore, I have read the infonnation contained herein ~d certify that thei~å~ö~ is" ,
true and correct. ,- " ,'::C:: :, ' "
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1;. Be;;;r!/1/"/ e ¿ N 6""/ L
- (:name)
~KNA/e
(ètty)
. 2929$: W4J'2:?(;k4.¿1 Þ.</v¿. .
'(address).,.
, ' bdng:first dW.y sw~ llpon
W#' . 9 :7'Zd3 oa:th. depose ;D)d say.
, (state)
1- .
That I 8.D11he record owner of the propcdy de:seaòcd on tlie attached,. -and I ~ my ~sion
u '.'
i?G/I ~/r&~/..s
(name) ,
s::-r;s- W ~ý¿7Zê ST-:-, .&.se; /.D
(address)' - ' -
2.
to ~bmit the ao:;:ompanyicg applú:;ation Pertainïog to that propäty.
I agree, to fudemni1ÿ. defë:ad 2nd boJd th~ Cityof:Meridian and it~s èmployees bamiles.s :from
any da1m,- or 1iàhi)Ïty resu1tmg ftam any dÏspute as to the statements contaìned hariri or as to
tbeownersbip o.ftheprope:rty~ wbÏcl1 i:s the subject oftbeapplicarion.
Dated this
/¥'
day of
~ LJ 6i'Jê.
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.200$
¿V
(Sigœb1re)
SUBSCRIBED .AND SWORN to bdOre m~ the da.:y .and year :first above ~
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R=. 11/03/03
1'6
t1'
ADA COUNTY REcORDER J. DAVID NAVARRO AMOUNT 9.00 a
~~W~A~~J~I~:05 _04:27 PM II! ¡UIIIIJllflUIIIIJJIIIIIIII Ifill
REtORDED-REQUEST of 1£15071828
FirstAllletican
.
:-~'
AFTeR RECORD!NG MAIL TO:
Touchtnark of the Treasure Va/fey, LtC
P.o. Box.135S
" Meñdian, Idaho 83680
0 ) ILD- PC-
QUITCLAIM DEED
Da.te~ MayaS, 2005
For Value Received. Touchmark or the TreáSure valley, LLC, do(es) herçby COltVey, relea~ remise,
¡¡oo forever quit claim unto Touchmark. of the TI'885Ure Valley, Ut, whose addt'e$ Is P.O. Box
1355, Meridian, Id;¡lbo 83680, the following described p~rse$ln Ada County, Idaho, ta-wIt:
See.legal- desaIp~on-attached heretO-and -maf!el' a- part- hereof
mgether with their appurtenances.
DatEd;
~~P...
:,2005
7
--. ------------.. -------_u-_____,n_"'-
Toudlmarkoftl1e Tr'eaSUre Valley. LLC
By: ToUChmark, LLCJ Managing Member
By: Tourmark Living Cenœ!'5r Inc., Manager
By; /~/),~
Werner G. Nistler, Jr.J C§O
Pag.::1Of 2
- - n -- -- ------ n____--_-----
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FROM: SOUTH LANDSCAPE ARCHITECTURE
F.
G.
PHONE NO. : 2083422993
Aug. 08 2005 11:42AM P2
H.t4NJ t~
$Ð~ ~~, Þ,C.
TO:
FROM:
DATE:
RE:
.CC:
Eric Anderson, ZGA Architects
Tom South
August 8, 2005
Dr. Wigod Clinic, Meridian, Idaho
Kristy Vigil
-'
The fol1owing catcqlations are fi:om Item No. i 3 from the Landscape Plan. Submittal Checldist for
Conditional USe pennit. .
A
Number of street trees - 2 (Plus one for east boundary requirements), and lineal feet of
street frontage - 50' (oflandscape frontage at property line, approxímately 80' at setback)-
B.
Width of street buffers - 20', on E. Louisa Drive. 20' on private Drive on west side.
c.
Width of parking lot perímetcr landscape strip - 20' front / E. Louisa Drive, 20' on private
Drive on west side, O' to 29' on East Property Boundary.
D.
Buffer width between different land uses - not applicable (same land uses)-
E.
Number of parking stalls - 13, and percent of parldng area with. intemallandscaping - ;not
applicable (lot size does not require internal planters).
Total number of trees - 15, arid tree species mix - 4 species (Autumn Blaze Maple, Skyline
Honey Locust, Spring Snow Crab, and Capital Pear). .
Mitigation for removal of existing trees - not applicable (no e?,isting trees on site).
-~'
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9.19.05
Architects and Planners, Chartered
Meridian Planning and Zoning
660 E. Water Tower Lane
Meridian, Idaho 83642
Thomas M. Zabala, AlA
Arthur M. Albanese, AlA
Michael G;' Simmonds, AlA
Steven C. Turney; AlA
RE:
Dr. Mark Wigod -
Certificate of Zoning Compliance
Revised Drawings, (CUP-05-043)
Job No. 0512.00
- To Whom it may concern,
Attached, please find the revised drawing for the CZC application and a
copy of our previous submittal. The drawings have been modified
according to MCC 12-13-11. As a result we ask that one parking stall be
allowed a reduction of l' -0" to make it 8'-0" wide instead of9'-0" wide.
Thank you for your review of the project, we look forward to your review
comments. Please feel tree to call with any questions you may have to this
submittal - '
Sincerely,
ZGA Architects and Planners, Chartered
8
~
Eric M. Anderson
-
-
Members
American Institute of Architects
cc:
File/Div.A
565 W. Myrtle Street, Suite 225
Boise, Idaho 83702-7606
, (208) 345~8872
Fax (208) 343-7162
e-mail: zga@zga.com
Established 1973
Plastic and
Reconstructive
Surgery
Cosmetic
Surgery
Hand Surgery
Diplomate
Am.erican Board
of Plastic Surgery
Diplomate
Am.erican Board
of Surgery
Fellowship Trained
Hand Surgery
- Mark D. Wigod,MD,PA
8756 W. Emerald St. -
, Suite 186
Boise, Idaho 83704
Tel: (208) 377 9515
- --Pax: (208) 377 9517
wWw. W!3 orf com
MarK t[} 111&01, MfJ, ~J[cs
+
P(às{ic Su'jery
To'whom it may concern,
0
Member
AMERICAN SOCIETY OF
PLI'SIlC SURGEONS
This 1etter)s to detai11;he proposed use ofland purchased from Touchmark
by Wigod Properties, LLc.
I am a solo Plastic Surgeon. I plan to build a building for the use of my
private practice, as well as any future partners I may have. The building
will be approximately 4500 square feet on approximately 21,000 square,
feet of land. Inside will be facilities fora clinic, ambulatory surgical suite,
alld aesthetician services. These proposed uses have been reviewed by
- Touchmark and St. Lukes Medical Center and neither party has any
objections.
I would be happy to provide more detailed explanations if~equired.
SinÓere-ly,
/~h~- /~ '
/ ¿'/~-, ~
MarkD. Wigod, MD, FACS
---"
GA ARCHITE:G 1:S ANU l-'LANNt:H:S
!!ndor 10:, MERIDIAN
leek Amount: 60.00
CITY OF MERIDIAN
,10 i ce #
;614
Date
07/14/2005
Invoice Amount
$60.00
Gi"Oss Payment
$60.00
Discount
Net Payment, Notes
$60.00 0512
Check # : 22668
Date: 07/1412005
22668
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PROJecT: Dr. Mar" UJl9od Clinic and A5C
DRAIIN 81: EMA ~ . =::E AU
07/13/2005 09:44 FAX 3275514
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TITLE DEPT
141002
ADA. COUNTY RECORDER J. DAVID NAVARRO AMOUNT 9.00 3
BOISE IDAHO 06(03105 04:27 PM
DEPUTY Vicki Allen III IIßIIIIH 111111 11111 II 1111 II II III
RECO"D!~-FtEQUfST OF 1 05071828
First Ametlcan
AFTER RECORDING MAIL TO:
Touchmark of the Treasure vaney . LLC
p ,0. Box 1355
Meridian, ldal1o 83680
--111ILD~ pG
QUITCLAIM DEED
Date: May 05, 2005
For Value Received, TolIChmark of the T.....sure valley,. LLC, do(es) hereby convey, relea$e¡ remise.
and rarever quit œ.ilt1 unto Touc:::hmark of the Tl'1UIol'e Valley, u..C, whose address Is P.O. Box
1355, Mel'ldlan, Id;Iho 83&80, tlte ñ:lliowing described premIses In Ada CaUl\ty, Idaho, tD-wlt:
See legal description attar:hed. hereto and made a part h8W30f
together with their appurtenances.
Dated;
~~P...
7
, 20 C. E:a.
TOUChmark or the Treasure Valley, LLC
By: Touchmark, LLC, Managing Member
BV: Tourmark Uving Centers, Iflc., Manager
By:L~ I). ~
Werner G. Nistler, Jr.1 CEO
PII~lCrfl
07/13/2005 09:44 FAX 3275514
TITLE DEPT
IlJOO3
-""'
APN:
Qultc.faim Dæd. - mnllnul!d
Date; O$/DSf2IJG5
STAT1: OF ~~ )
Q 55.
COUNlY OF ~~, ~ )
On this ~~ day Df ]une, 2005, before me, a Notary Þubllc In and for said State, pel'SOnany
appeared Werner G. Nistler, Jr., known Or identiñoo to me to be the petÇOn whose name is subscribed
to the within instrument as CEO ofTDuchmark LMng Centers, Ine., Mllnager of Touch mark, L1.C,
MaMglng Member at the Touchmark of the Treasure valley, lLc, limited liability company, and
acknClWtedged to me that sud1lhnlted oompally executed 5ame.
In witness whereof, I have tlereunto set my hand aod affixed my official seal the day and year in this
œrtI!'ü:ate first above written.
., OFFICIAL SEAL
ADRIA M WRIGIofT
NCOOTMT PUBUc-o.~.EGON
MMISSION ""- 391394
"., COMMISSION EXPIRES APR 5. 2009
~~.~
Notary Public WI' the State of ~
Residing at , ~er'=~ ~ - ~ .
~
My COmmission Expil'eS:
~; \ ~ ") ~""\
-
Page2OfZ
07/13/2005 09:44 FAX 3275514
TITLE DEPT
I4J 004
~/'f9~37
r
EXHmrT A
LEGAL DESCRIPnON~
Parcel C of Record of Survey No. 6821, recorded March 4, 2005, 8S Instrument No. 105026736, and
being a parcel of land being a portion of lot 1, Block 2 of TOUæMARK lIVING ŒNŒR SUBDMSlON
NO, 1, ao:ordlng to the plat ttlereof, filed In Book 89 of PlatS at pages 10313 through 10316, recardfi of
Ada CoUl'\ty, Idaho, being a portIOn of the Northwest Quarter of Section 16, TownStllp 3 Nortn, Range 1
East, Boise Meridian, aty of Meridian, Ada O:nmty, Idaho, more partlcular1y descrIbed as foIJoW5:
Comrnel'ldng at the Northwest œmer of Section 16, Township 3 North, Range 1 East; Boise Meridian,
CIty of Meridian, Ada County, Idaho; thence South 8901028'47" EiI5t 1015.45 feet along the North One of
the Northwest Quarter of said Section 16 to a point; thence South OOC20'!]'. East 50,01 feet to a point On
the South right of wav of E, Franklin Read, the Northwest mmer of Lot 1, Black 2 of Touchmark Uvlng
Center Subdivision No.1, filed in Book 89 of Plats ;;It Pages 10313 througtll0316, Ada County Recorder's
Offiœ¡ thenœ c::ontlnulng South 0001020'17' EaSt 483,55 feet along the West nne of said I.Dt 1 tD a point;
thence North 89°39'43° East 165,00 feet to a poInt; thence SOuth 00020'17" East 21,82 feet tc the REAL.
POINT OF BEGINNING of thts description; thenCE! North 891t39'43" eaSt 154.03 feet to a paInt; thence
South OO~O'17" East 117.04 feet to II point on the Northerly right of W8Y of e. louise Olive; thence
South 380044'36" West 89,88 feet along said Mortherfy right of way to a point; thence North 36°15124"
West 119.77 feet to a point of curvature; thence along a curve to the rlgl1t 31,34 feet, said curve having
a radius of SO.OO feet, a central angle of 35055'07", tangents of 16..21 feet, ;¡md CI chord whIch bears
North 181:117'50" West 30,83 feet to a point or l:angency; thenœ North CXf'2D'l7" West 36,19 feet to the
REAl POINT OF 6EGINNING of this desa1p1:1on.
....
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(Þ~~l~" CITY OF
.~ ,1,
erlOLlãn
33 E. Idaho Ave.
Meridian, ID 83642
Applicant
Address
~l~
5948
TOTAL
TAX
94790
() D
!Y~~oa
Received
By
AFFIDAVIT OF LEGAL INTEREST
STATE OF IDAHO )
)
COUNTY OF ADA )
I,
/l; ffrC/ cD.
(name)
ßotsr¿
(city)
WI Ú7JD ,
'.-IS)
(state)
8 7 ~ fA) ~ £V£ IC/t1J)
(address)
being first duly sworn upon
oath, depose and say:
8370&(
51-
-rH't!":'
1.
That lam the record owner of the property described on the attached, and I grant my
permission tp:
~A. Atd1,-kc:b
(narn~)
(address)
to submit the accompðnying,application pertaining to that property:
2.
I agree to 'indemnifY, defend and hold the City of Meridian and it's' ,employees
hamilessftöm arty chum or liability tesu11ing ftom any dispute 'as to the statements
contaÎ1led herein or as to the ownersmp of the property, which is the, subject of the
application.
Dàtedthis
?/9
dayof-3~
,2005 .
"
\
2~
./ . , nature)
SUBSCRIBED AND SWORN to before me the day and year ftrstabove written:
. S;~ 10/.~
-
Notary PUbli~ Idah~ ~ ~
Residing at "t'/"/ ';u, J./r. 0
My Commission ExPites:~
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Rev. 11103/03