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Agreement to Conduct Permitting by Electronic Means <br /> Name of permittee ve re resentati desiring to , <br /> opt in to ePermit: p g �0,U t L c4- <br /> Name of permittee: <br /> Title: <br /> Nt.d b-P <br /> Signature: <br /> Email Address for ePermit Account: <br /> Notarized Affidavit of Signature <br /> STATE OF: 0 � <br /> COUNTY OF: ) ss. <br /> V,�� AT61V <br /> The foregoing instrument was acknowledged <br /> before me this day of by <br /> (date) (y ar) <br /> a <br /> as <br /> Ceti' �. � <br /> (Name of permittee repre entative) (title) <br /> of WVl �'lV� <br /> =NotaryID <br /> BBINS (permi tee) <br /> blic <br /> orado <br /> 4036,938es Nov 20, 2017 NOTARY PUBLI <br /> (seal) <br /> My Commission expires: <br /> 11 0 <br /> Page 3 of 4 <br />