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czc checklist�C01, i%U1`Y OF ADA M (name) ' (city) being first duly sworrr upon, oath, depose and say: (moo ) Gam' 1. That T am the record otivner of the property described oa the attached, and I grant �y permission to: crr — f (name) (address) 14 i to submit the accompanying application(s) pertaining to that property. �. I a�ee to indemnify, defend a€�d hold the City of Meridian ,and its employees ha�nless fraru 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. I hereby grant permission to City of Meridian staff to enter the s�tb}ect properly for 41�e parpose of site inspections related to processing said applicatior!(s), I}ated this day of( - - ----- 20 =_--- --- - I.A4�RA l.A�lDFtkTH �lotary P�blle -State oaf ldah© Gamrhissio� td�mber 20?0l©11 AAy C.Q1Yltilisslon Expires May 28, 2026 �Signai`�re� c for Idaho) Residing at:� ��i My Co�ssi0n expires: a� 33 E. 3raadnay .venue, Suite 102 � ,�i�r�dian, Idaho 33b�2 Pone: {ZOII) II$7-?231 R Facsimile: (208j IIII?-1297 a �ebsite: E��a.meridiancit�,orb SxA4�T� 4�' mA�O ) tc��') being fu�st duly sworn upon, oath, depose and say: tstate) I. That I am the record owner of the property described on the attached, and I grant my ermission ta: to submit the accompanying applioatipn{s) pertaining to that property. 2. r agree to indemnify, defend and hold the City of Meridian and its employees harmless frbnY any claim or liability res�rlting frorn any dispute as to the statements contained herein or as to tl�c owiicrship of the property which is the subject of #hc application. 3: � hereby g��ar�t permission to City of Meridian staf% to enter the sub,�ect property £or the Pijrpc�s� £site inspeetic�ns rciated to processing said applicatioaCs}. D€�ted'tt�is �,� rJ�ay of t � � � �. - . 2t)..�,`.. M- ,.,,.,,..y._.,� a �"�'"�` ^ram_ g {�i�tai�r�� ane the day and year i`�t above written. �;s:dy���`��i ��. ��� 'f�`� b�,�a Residing At; � - � ��. �� (Notary public #'or �ct�t�a} *'=�j 1 �� q�� CC��tilll��Si���719e����� .._._ itrr�w N©TA�Y Pl1f�f�f� State of Idaho fV1y �omrnfssfon frxpirss 10l�A/�0?� 33 tr. nri�nd�rny Avenu�ey S»Itu }02 • Mcridfan, Ids1�a 83frt� Ptjonc. (2p$) $$7-�2! l • Faasi�i#t�, t20$) $$7�tz�7 + V1►ctfstta: ��n�,�.11if;l`!(IteiflCfty.cirL