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'Agreement to Conduct Permitting by Electronic Means <br /> Name of permittee representative desiring to <br /> opt in to ePermit: James Cooley <br /> Title: President <br /> Nameofpermittee: Cooley & Sons Excavating , Inc . <br /> Signature: / <br /> ePermitting Administrator(if different from 7 <br /> representative signing agreement) Donna Cooley <br /> Email Address for ePermit Account: C o 01 e y a n d s o n slr g m a i l . corn <br /> Notarized Affidavit of Signature <br /> STATE OF: ) <br /> COUNTY OF: ) ss. <br /> The foregoing instrument was acknowledged <br /> before me this 26DL day of `ft/6AI, , aq0/‘ by <br /> (date) (month) (year) <br /> as <br /> d/int)) dr-rf,Let <br /> (Na e of permittee representative) (title) <br /> of Zai, <br /> (permittee) <br /> aa <br /> OTAi? 1 i1BLIC <br /> SHIRLEY L WITHERSPOON <br /> (seal) NOTARY PUBLIC <br /> My Commission expires: STATE OF COLORADO <br /> NOTARY ID 19914001387 <br /> j/7 g 0/CI MY COMMISSION EXPIRES MARCH 7,2019 <br /> Page 3 of 6 <br />