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Agreement to Conduct Permitting by Electronic Means <br /> Name of permittee representative desiring to //''�� <br /> opt in to ePerinit: M 1'n 1.-h1( I.S e v Se✓\ <br /> Name of permittee: -R)uv- X--Rav1C17), "C <br /> Title: <br /> n. <br /> Signature: tb t (Zi.4—",e)70,--1479-g--c,-. <br /> �r � <br /> Email Address for ePermit Account: CY'1�n A ccar vnm ra l ( , CO <br /> Notarized Affidavit of Signature <br /> STATE OF: )10/0 Yi.Z.lu <br /> COUNTY OF: ) ss. <br /> ./V�a << <br /> The foregoing instrument was acknowledge <br /> before me this //Pr' day of 2V/6 by <br /> (date) (year) <br /> t GM v-'1 - Y\R.Ince as <br /> h1cx �re S.1 Ci•Q v # <br /> (Name of permittee representative) (title) <br /> of t•_. <br /> • r ,a <br /> in X ;RUvlck , in c._ . <br /> (permittee) <br /> CHRIS R. DOLLERSCHELL <br /> S NOTARY PUBLIC /// /4221/ <br /> /// <br /> STATE OF COLORADO elo C , <br /> NOTARY ID 20004017433 <br /> o MY COMMISSION EXPIRES JUNE 14,2020 NOTARY POVLIC <br /> (seal) <br /> My Commission expires: <br /> /V42;20 <br /> Page 3 of 4 <br />