CT_CZC_AffidavitSTATE OF IDAHO )
COUNTY OF ADA )
AFFIDAVIT OF LEGAL INTEREST
(name) (address)
(city) (state)
being first duly sworn upon, oath, depose and say:
That I am the record owner of the property described on the attached, and I grant my
permission to:
David Blodgett, Architect 199 N Capitol Blvd, Suite 602, Boise, ID 83702
s
(name) (address)
to submit the accompanying application(s) pertaining to that property.
I agree to indemnify, defend and hold the City of Meridian and its employees harmless
from any claim or liability resulting from any dispute as to the statements contained
herein or as to the ownership of the property which is the subject of the application.
I hereby grant permission to City of Meridian staff to enter the subject property for the
purpose of site inspections related to processing said application(s).
Dated this day of 4 , 20
( nature)
SUBSCRIBED AND SWORN to before me the day and year first above written.
PAULA M DULANEY
COMMISSION NUMBER 24619
NOTARY PUBLIC
STATE OF IDAHO
MY COMMISSION EXPIRES 09/19/25
(Notary Public for Idaho)
Residing at:no l �L A LOA, ► i!
My Commission Expires:(
Community Development r Planning Division ■ 33 E. Broadway Avenue, Ste. 102 Meridian, Idaho 83642
Phone: 208-884-5533 Fax: 208-888-6854 www.meridianc .org�pIanning