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Agreement to Conduct Permitting by Electronic Means <br />Name of permittee representative desiring to <br />opt in to ePermit: ."U€L j <br />Name of permittee: <br />Title: <br />Signature: <br />Email Address for ePermit Account: <br />STATE OF: <br />COUNTY OF: <br />L <br />7 <br />4#e%s LI,ue_A;;- <br />h/Ou e iry . ao% C,cryri <br />Notarized Affidavit of Signature <br />(16 USA -)0 U ) <br />The foregoing instrument was acknowledged <br />before me this <br />2u/L7 Xia.cLi�„ <br />(Name of permittee representative) <br />BRIAN WINKLER <br />Notary Public <br />State of Colorado <br />Notary ID 20134040690 <br />My Commission Expires Jul 1, 2017 <br />(seal) <br />My Commission expires: <br />ss. <br />day of STAN' . a..)/6 by <br />Page 3 of 4 <br />7 <br />NOTARY PUBLIC <br />