Laserfiche WebLink
Agreement to Conduct Permitting by Electronic Means <br /> Name of permittee representative desiring to <br /> opt in to ePermit: fW Ili <br /> Name of permittee: S <br /> Title: <br /> —,bud <br /> ht w� <br /> Signature: <br /> v , <br /> Email Address for ePermit Account: <br /> Notarized Affidavit of Signature <br /> STATE OF: ) <br /> �' o I Urcccl.a <br /> COUNTY OF: ) ss. <br /> Los Arntin► s <br /> The foregoing instrument was acknowledged <br /> before me this +h day of Nl MWR 7'01(, by <br /> (date) (year) <br /> as <br /> V\kCLctC 2. l_a�A-d erg 16"Ir wia <br /> (Name of permittee representative) (title) <br /> of <br /> (permittee) <br /> =ID199MO <br /> HAVEZ <br /> BLIC r� <br /> ORADO ►^T <br /> 98M014199 NOT RY PUBLI <br /> IRES JUNE 03,2018 <br /> (seal) <br /> My Commission expires: <br /> OCR 03 20 l F) <br /> Page 3 of 4 <br />