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'Agreement to Conduct Permittin b Electronic Means <br /> g y <br /> R ��I►111 t <br /> a AF'R 0 6 2016 �Y�� 07-7 <br /> Name of permittee representative desiring to � OF RW1A1AAT IA,, <br /> opt in to ePermit: � 0 <br /> Title: <br /> Name of permittee: <br /> Signature: <br /> ePermitting Administrator(if different from <br /> representative signing agreement) <br /> NAVVWN (0 kC,l^dcvi AC c o <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 Marc k) aO i P by <br /> (date) (month) (year) <br /> as <br /> (Name of permittee representative) (title) <br /> of <br /> �,��o�aa�d Grc,vei <br /> KHRISTEN GONZALES-QUINTERO (permittee) <br /> NOTARY PUBLIC M `. • . -. <br /> STATE OF COLORADO <br /> NOTARY ID#20154012496 <br /> My Commission Expires March 27,2019 NOTARY PUBLIC <br /> (seal) <br /> My Commission expires: <br /> a1. � c, <br /> Page 3 of 6 <br />