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Agreement to Conduct Permitting by Electronic Means <br /> Name of permittee representative desiring ton <br /> opt in to ePermit: Randy M C C f(_.r e_ <br /> Name of permittee: <br /> Rio (,rand,. 5-Li UCr, Lex, <br /> Title: C►OhstJJ+Cthcf <br /> Signature: /. /11('C- ►►'1p10 <br /> Email Address for ePermit Account: <br /> rrY1Cfiure necic.-Mi nisi , Cow\ <br /> Notarized Affidavit of Signature <br /> STATE OF: ) <br /> CO lar <br /> COUNTY OF: ) ss. <br /> The foregoing instrument was acknowledged yy <br /> before me this -f day ofitaritt- ZC>l 6 by <br /> (date) (year) <br /> ► t' I c c I LA(T.._ as <br /> RcrcI1 Cov\s u(4-41;If <br /> (Name of permittee representative) (title) <br /> of r. <br /> R Grc r 31-I0Pr enc . <br /> (permittee) <br /> CECILIA M. MCNEEL <br /> NOTARY PUBLIC O <br /> STATE OF COLORADO Adit) <br /> NOTARY ID 20154016485 <br /> MY COMMISSION EXPIRES APRIL 27,2019 NOTARY P LIC <br /> (seal) <br /> My Commission expires: <br /> 0`-/- O7 - <br /> Page 3 of 4 <br />