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Agreement to Conduct Permitling by Electronic Means <br />Name of permittee representative desiring to <br />opt in to ePermit: MC1.r �1 A NZ, car rCXc 0. <br />Name of permittee: k. A 0o n c re le Co K 5 br <br />Title: <br />Pr e,5. de n <br />Signature: rr <br />Email Address for ePermit Account: M a e b <br />Notarized Affidavit of Signature <br />STATE OF: Co6rcLdo <br />COUNTY OF: T ss. <br />The foregoing instrument was acknowledged h <br />before me this <br />(date) <br />day ofTul-201 (o by <br />I (year) <br />as �7 <br />mo -rho Azc&rrc�.a[.-k I'res,den+ <br />(Name of permittee representat' ) (title) <br />(seal) <br />My Commission expires: <br />of <br />(permittee) <br />to- ACV- 101'? <br />Page 3 of 4 <br />NOWN''Wal, <br />NOTARY PUBLIC <br />COLLEEN HELEN VAUGHN <br />NOTARY PUBLIC <br />STATE OF COLORADO <br />NOTARY ID #20144025273 <br />My Commission Expires ,lune 26, 2018 <br />