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Agreement to Conduct Permitting by Electronic Means <br /> Name of permittee representative desiring to <br /> opt in to ePermit: Rr MC l.-/ <br /> GA i"lG ' " ' I l�C <br /> Name of permittee: R C7 ra P C{e 5Lf ve r� Lnc <br /> Title: <br /> COASU_Ii-Ctrif - <br /> Signature: oC- <br /> � `e ►►�10 /�'� <br /> Email Address for ePermit Account: <br /> rm(fJLcre C hecJct ..rig ninS , Cow\ <br /> Notarized Affidavit of Signature <br /> STATE OF: ) <br /> CO I ora.o <br /> COUNTY OF: ) ss. <br /> The foregoing instrument was acknowledged <br /> before me this 7 day of/lar,L- 2O/6 by <br /> (date) (year) <br /> RCMC)/ ► ► I C I I,i rt as CONS LA(4'et VI+ <br /> (Name of permittee representative) (title) <br /> of <br /> R GrGlile &suer , -T . <br /> (permittee) <br /> CECILIA M. MCNEEL <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> 1.i91/(A: A.Vat) <br /> NOTARY ID 20154016485 <br /> MY COMMISSION EXPIRES APRIL 27,2019 NOTARY P LIC <br /> (seal) <br /> My Commission expires: <br /> (-)`-/- O7 - is <br /> Page 3 of 4 <br />