HomeMy WebLinkAboutAFFADAVIT - 16-00047 - 134 & 145 E Main St - Courthouse Security Upgrades - Phase 1'*Building Permit Fees are due at time of applications "Building Permits arc cold if your check does not clears
Building Safety Department o4aneke;a
35 N to E City of Rexburg C 'x
Rexburg, ID 83440 •>
www.rexburg.org
Phone: 208.359.3020 Fax: 208.359.3022 Hotline: 208.372.2344 or Text: inspections@rexburg.org
Affidavit of Legal Interest
State of Idaho
County of Madison
I Madison County 134 E. Main St.
Name Address
Rexburg
City
Being first duly sworn upon oath, depose and say
Idaho
State
CITY OF
REXBURG
cw_._..._._
America's Family Community
(If Applicant is also Owner of Record, skip to B)
A. That I am the record owner of the property described on the attached, and I grant my
permission to: GPC Architects 189 N. Main St., Ste. 112, Driggs, ID 83422
Name Address
to submit the accompanying application pertaining to that property
B. I agree to indemnify, defend and hold Rexburg City 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. '
Dated this OZJ`— day of c J��20�/
Subscribed and sworn to before me the day and year fust above written.
OH'd01 d0 31`d1S
onand ,t21tl10N
2lifla'H WIN
Notary Public of Idaho
i
Residing at:
My commission expires:llS/6�i
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Subscribed and sworn to before me the day and year fust above written.
OH'd01 d0 31`d1S
onand ,t21tl10N
2lifla'H WIN
Notary Public of Idaho
i
Residing at:
My commission expires:llS/6�i