RESPONSIBLE PROF(1) Disk with electronic version of the conceptual engineering plans in the format specified
above.
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AVYIDAvrr yr LllbuAL 11"' , a�11Cn71
STATE OF IDAHO
COUNTY OF ADA
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(name) (address)
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(city) (state)
s
being first duly sworn upon, oath, depose and say:
1. That I am the record owner of the property described on the attached, and I grant my
permission to:
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i-somas R ,u,l\t4rv�5 _, S15 � PRtz�cu.��� c+ 3��bt. �\-.) e3-7u�
(tee) (address)
to submit the accompanying application(s) pertaining to that property.
2. 1 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.
3. 1 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).
20
Dated this day of 1�ot I ——
��
(Signature)
SUBSCRIBED AND SWORN to before me the day and yearA first above written,
I
ALANA G. PIERCE (Notary Public for Idaho)
COMMISSION #16641-
NOTARY PUBLIC
STATE OF IDAHO Residing at:
My Commission Expires: i
Community Development a Planning Division ■ 33 E. Broadway Avenue, Ste. 102 Meridian, Idaho 83642
Phone: 208-884-SS33 Fax: 208-888-6854 w meridimKity ora/olanning