2016-04-07_REVISION - M1979045

• Permit No: M1979045
• IBM Index Class Name: Revision
• Doc Date: 4/7/2016
• Doc Name: Request TR04
• From: The Lakewood Brick and Tile Co.
• To: DRMS
• Type & Sequence: TR4
• Email Name: MAC
• Email Name: WHE
• Media Type: D
• Archive: No

CONTRACTOR:
By: Perry S. McKay
ATTEST:
STATE OF :.
)ss.
County of , _ )
The foregoing instrument was _acknowledged before me this h day of
2015 by as
of ,
WITNESS my hand and official seal.
STEPHANIE L. HUSS
NOTARY PUBLIC
(SE �T�OF COLORADO r�
NOTARY t0 N 2002A027288
MY COUMISSION EXPIRES AUGUST 23,2018 Notary Public
My commission expires:
10