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Agreement to Conduct Permitting by Electronic Means <br /> Name of permittee representative desiring to <br /> opt in to ePermit: Randy/ �,/� <br /> " I c l.,i tic l' <br /> Name of permittee: R t.U C7 ra nide ��I ve r Ev c • <br /> Title: C O n S J+a ri l <br /> Signature: <br /> /COVY'Cli <br /> y,(CCJ , . 7r _ (/�^ <br /> Email Address for ePermit Account: <br /> rr►l(IJure C hec.JcL-r►inin9 $ CO V1/‘ <br /> Notarized Affidavit of Signature <br /> STATE OF: ) <br /> CO l Gr <br /> COUNTY OF: ) ss. <br /> vreArcN <br /> The foregoing instrument was acknowledged ,yy <br /> before me this day of tar-d .- ZC7l(, by <br /> (date) (year) <br /> RPAG)/ I rc_ as Cdr LA 441►'1f <br /> (Name of permittee representative) (title) <br /> of <br /> R GrCinde nuPr , TrI <br /> (permittee) <br /> CECILIA M. MCNEEL <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 20154016485 ' 6441-Ls, Aad <br /> MY COMMISSION EXPIRES APRIL 27,2019 NOTARY P LIC <br /> (seal) <br /> My Commission expires: <br /> 0`1- O7 - id <br /> Page 3 of 4 <br />