HomeMy WebLinkAbout19-00584 Notarized Permission to commencepf x RUp
C: I T Y O F
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Building Safety Department
City of Rexburg
35 North fst East
�,>ie.rz,s Pa,n,t} c.o»amtarrry Rexburg, Idaho 83440
Affidavit of Legal Interest
State of Idako
County of Madison
I 1 1) a�' . - �
Name
City
Being first duly sworn upon oath, depose and say:
(If Applicant is also Owner of Record, skip to B)
�G 30 e" '/'
Address
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State
A. That I a►' the record aw r of the property described on the attached, and I grarxtrr�err� t
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 09704- day of 9z 20Iq
Signature
Subscribed and sworn to before me the day and year first above written.
Residing at: "C)L.__.(_._h i, Z O YA
My commission expires: 6 2C1 h6 LL
tr speamn Hotline - (208) 372.2344 wwwrexburg.org Permit Technician - (208J 372. 341 Reprised W/2016