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Agreement to Conduct Permitting by Electronic Means <br /> Name of permittee representative desiring to C <br /> opt in to ePermit: Ra nd-y Lk r P— <br /> Name of permittee: <br /> RL'v ((7rc�► 1� SDI vex, LY)C, <br /> Title: C o n s Cklta d <br /> Signature: 1 f <br /> Email Address for ePermit Account: r i Ix.-(., 6 h + rn A n(+ W\ <br /> 1.0 <br /> Notarized Affidavit of Signature <br /> STATE OF: ) <br /> or r.,J.0 <br /> COUNTY OF: ) ss. <br /> The foregoing instrument was acknowledged <br /> before me this ��' day of&,,iA- Z0/ by <br /> (date) (year) <br /> RQ 1)C)L'I W)r-C I Ll rr- as <br /> (Name of permittee representative) (title) <br /> of <br /> (permittee) <br /> CECILIA M. MCNEEL <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 20154016485 _ <br /> MY COMMISSION EXPIRES APRIL 27,2019 NOTARY PUBLIC <br /> (seal) <br /> My Commission expires: <br /> Page 3 of 4 <br />