HomeMy WebLinkAboutAFFIDAVIT - 17-00695 - 66 E Main St - Progrexion - Remodel0
CITY O F
R.EXBURG
Amerlcds Family Conmrunlly
Affidavit of Legal Interest
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
State of Idaho
County of Madison I 1
I, $A1 l ?— lt��(i �GM�6i��Ttr CJ2iyC
Name Address `
City State
Being first duly sworn upon oath, depose and say:
(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:
Construction Solutions Co. 2880 E 14th N, Ammon, ID 83401
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
6th
day of November 20 17
Signature
Subscribed and sworn to before me the day and year first above written.
PAULA J. LEWIS
�jh Q NOrARYP0Z*S7A1Eo/UrM
COMNIS8ION NO. 610112
COMM. EXP. 0249.2020
Inspection Hotline- (208) 372.2344
Notary Pyrblic of1dah76
// V v -
Residing at: BC/'9l7i/
My commission expires:% aoa/1
w .rexburg.org Permit Technician -(208)372.2341 Revised 10, 2016
C I TY OF
RE BVRG
Amcri&6 Family Cmnnwnily
Affidavit of Legal Interest
Building Safety Department
State of Idaho
County of Madison
I, W i 1o) -k M G
Name Address
1't- k L�64
City State
Being first duly sworn upon oath, depose and say:
(if Applicant is also Owner of Record, skip to B)
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
A. That I am the record owner of the property described on the attached, and I grant my permission to:
Construction Solutions Co, 2880 E 14th N, Ammon, In 83401
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 6th day of November 20 17
Signature
Subscribed and sworn to before me the day and year first above written.
PAULA J. LEWIS
g NOTARYMMMoSTA1EdUTM
COMMISSION NO. 687212
COMM. EXP. 02-08.2020
Residing at:
My commission expires:
Inspection Hotline- (208) 372.2344 a wxexburg.org Permit Technician- (208) 372.2341 Revised 10, 2016