Laserfiche WebLink
U Agreement to Conduct Permitting by Electronic Means <br /> [q?�- 050 , , _y 6 z &—f <br /> Name of permittee representative desiring to .� <br /> opt in to ePermit: <br /> Title: �� <br /> < ,E�;kdT <br /> Name of permittee: <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: n ) <br /> COUNTY OF: ) ss. <br /> The foregoing insbrdme as acknowledged �----day <br /> before me this of by <br /> (date) (month) (year) <br /> as <br /> (Name of perfnittee repr s tative) (title) <br /> of <br /> �-� (permi ee) <br /> CAROL WRIGHT <br /> NOTARY PUBLIC <br /> STATE OF COLORADo <br /> NOTARY ID#200940403 22 <br /> MY COMMISSION EXPIRES DECEMBER 09.2017 <br /> TARY UBLIC <br /> (seal) <br /> My Commission expires: <br /> to;2 o c 7 <br /> Page 3 of 6 <br />