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Agreement to Conduct Permitting by Electronic Means <br />Name of pennittee representative desiring to <br />opt in to ePermit: <br />Name of pennittee: <br />Title: <br />Signature: <br />Email Address for ePermit Account: <br />vit (kt-L ( a <br />iv\devta s L L <br />Liztld r,Aap €_' <br />Ju tic'.; IYItktdacCO14/12dtit Mar ie. z.C.evu, <br />Notarized Affidavit of Signature <br />STATE OF: ) <br />C(ora-do <br />COUNTY OF: <br />t. cl r L m,e1r <br />The foregoing instrument was acknowledged <br />before me this <br />du. lie__ v , kms.las <br />(Name of permittee representative) <br />MARIAH L VIGIL <br />NOTARY PUBLIC <br />STATE OF COLORADO <br />NOTARY ID 20154041600 <br />MY COMMISSION EXPIRES OCTOBER 22, 2019 <br />ss. <br />)21 /� ( <br />day of v (J by <br />(date) (year) <br />as <br />of <br />Nta ric& c�-e_I- <br />(title) <br />I v lit. V`+- t I. \1. _ tr I f'. 1 Tc . Mar1 Q [Slit', <br />j <br />(permittee) <br />gi(V/ <br />NOTARY PUBL <br />(seal) <br />My Commission expires: <br />t A 0_10 <br />Page 3 of 4 <br />