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Agreement to Conduct Permitting by Electronic Means <br />Name of permittee representative desiring to 1 <br />opt in to ePermit: 0 p b r44 Lia a rlR e <br />Name of permittee: ' Q I . S S ,byw— /iO <br />Title: (. <br />'� resi d erg <br />Signature: QjU <br />Email Address for ePermit Account: �0 h `C A n-5 S rL — LC? m <br />Notarized Affidavit of Signature <br />STATE OF: <br />( e%rc2G'E� <br />COUNTY OF: ) ss. <br />a. <br />The foregoing instrumdWvas acknowledged <br />before me this t4— day of <br />(date) <br />as <br />(Name of permittrepresentative) (title) <br />JOE VALENZUELA <br />NOTARY PUBLIC <br />STATE OF COLORADO <br />1MYCOM10N RAKES A A 8, 2020 <br />(seal) <br />My Commission expires: <br />I ✓ i <br />/G by <br />(year) <br />of / tS!/1 D/o-.��IS <br />(permittee) <br />Page 3 of 4 <br />V <br />,P,ARY PUBLIC <br />