5/21/2021 8:08:45 AM
5/19/2021 10:06:31 AM
Notice of Application
Applicant Name (LN, FN)
Amos, Meg (Marine Survey & Assessment)
Bayside Seawall Project
The applicant is requesting a shoreline exemption for repair and maintenance of a 525-foot-long existing concrete seawall.
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Master Land Use Permit Application Page 4 of 4 <br />By affixing my signature hereto, I certify that I am the owner, or am acting as the Owner’s <br />authorized agent, and that the application and documents contained with this submittal are <br />complete and accurate to the best of my knowledge and abilities. If your title report lists a <br />company, partnership or other owners, you must submit evidence that you are authorized to sign <br />on behalf of the entity or others that are listed. <br /> <br />If you are an authorized representative you must submit an Agent Authorization Form. <br /> <br />Please attach additional signature sheets if there is more than one owner. <br /> <br />Under penalty of perjury, I certify that the information, statements, answers above regarding <br />the subject application(s) are true and correct to the best of my knowledge and belief. <br /> <br />Signature: Date: __________________ <br /> <br />Printed Name: ____________________________________ <br /> <br /> <br />STATE OF WASHINGTON ) <br /> ) ss. <br /> COUNTY OF SKAGIT <br /> <br />I certify that I know or have satisfactory evidence that _______________________________ is the <br />person who appeared before me, and said person acknowledged that he/she signed this instrument, <br />and acknowledged it as the free and voluntary act for the uses and purposes mentioned in this <br />instrument. <br /> <br />Given under my hand and official seal this _________ day of ________________, 20______ <br /> <br />____________________________ <br />Notary Public <br />(SEAL) Residing at __________________ <br />My appointment expires _______________ <br /> <br />
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