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Agreement to Conduct Permitting by Electronic Means <br /> Name of permittee representative desiring to <br /> opt in to ePermit: M A UR I C E LYRIC H <br /> Title: <br /> PReS1JC-ivT AA1-t) C Eo <br /> Name of permittee: KUNA,-/,vG-'IUA./6DV I-S0 .s'IR y/C-e�s L LC <br /> Signature: <br /> ePermitting Administrator(if different from <br /> representative signing agreement) <br /> Email Address for ePermit Account: <br /> Notarized Affidavit of Signature <br /> STATE OF: ) <br /> COUNTY OF: ) ss• <br /> The foregoing instrument was acknowledged <br /> before me this day of t=c3i r�u�1RY 2Q/� by <br /> (date) (month) (year) <br /> as <br /> (Name of permittee representative) (title) <br /> of <br /> ,RUNNI�C S C�� f-�-A V l S'oRy SCR l/(C CS <br /> (permittee) LLe <br /> FREDTNOTW MOORS --7t a4a� W a,� <br /> NOTARY PUBW <br /> REQ#7e8ne1 NOTARY UBLIC <br /> COMMONWEALTH OF vIRCR M <br /> (seal) <br /> My Commission expires: <br /> Page 3 of 6 <br />