Hold PHearing_Purchase of Real Property

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NOTARIZED STATEMENT 1, (the undersigned applicant) under penalty of perjury in the State of Washington agree to comply with all sections of this document, federal, state, and local provisions, codes, and ordinances in regards to water use. These covenants and agreements shall be binding on all parties having or acquiring any right, title, or interest in this land described herein or any part hereof and it shall pass to and be for the benefit of each owner thereof I certify that the information provided is true and accurate and I understand that if the project description should change that it is my responsibility to inform Kittitas County Department of Public Works (KCDPW) and that the department may require different and/or additional requirements. As the applicant, I assume all risk in its entirety and agree to indemnify defend and hold Kinitas County, its departments, elected and appointed officials, employees, and agents, harmless from and against any and all claims, damages, losses and expenses, including reasonable attorney's fees, for any bodily injury, sickness, disease, or death, or any damage to or reduction in value of property including the loss of use resulting there from which are alleged or proven to be caused in whole or in part by a negligent act or omission of its officers, directors, and employees. As the applicant, I understand that 1 am legally and financially responsible for ensuring there is a legal right to the water to be used, and that all water supply systems are engineered, designed, and constructed in accordance with federal, state and Iocal requirements. I understand that all applicable fees may be non-refundable and that KCDPW may have additional requirements to ensure that sufficient and adequate water supply is available for use and I shall comply with all requests made by KCDPW. Should i as the property owner choose to use and appoint an authorized agent to represent my interest, I may do so, by having myself and the authorized agent sign this notarized statement. Signed: Print Name: I, Authorized Agent Signature (if applicable): State of Washington ) 55 Property Owner(s) Property Owner(s) (the property owner) appoint, as an authorized agent to represent my interest. Authorized Agent Print Name; Authorized Agent County of ) 1, the undersigned, a Notary Public in and for the above named County and State, do hereby certify that on this day of , 20__, personally appeared before me, who is personally known to me whose identity I proved on the basis of _ whose identity I proved on the oath/affirmation of , a creditable witness to be the signer of the above instrument, and he/she acknowledged that he/she signed it. to me known to be the person(s) described in and who executed the within and foregoing instrument, and acknowledged that he/she signed the same as his/her voluntary act and deed, for the uses and purposes therein mentioned. Witness my hand and official seal hereto affixed (Notary Seal) Notary Public in and for the State of Washington, Residing in: My Commission Expires; Kittitas County Water Mitigation Application Page 3 of 5