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Agreement to Conduct Permitting by Electronic Means <br /> Name of permittee representative desiring to r /� <br /> opt in to ePermit: Fck MAC AeTty.L& <br /> Name of permittee: Nying. R2nregatcs <br /> Title: N hA NE e <br /> Signature: 1 / <br /> Email Address for ePermit Account: 4gr'ega-I,+eS � q rr►o►i�. GnM <br /> Notarized Affidavit of Signature <br /> STATE OF: 00/oy-(::� do <br /> COUNTY OF: ) ss. <br /> The foregoing instrument was acknowledged <br /> before me this o� day of by <br /> (date) (year) <br /> as No <br /> (Name of permittee representative) (title) <br /> of A10 I-M �e S <br /> (permi ee) <br /> BETH HEUS GAGNEBIN NOTARY PUBLIC <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY 10#19894006744 <br /> MY COMMISSION EXPIRES MAY 08,2017 <br /> (seal) <br /> My Commission expires: <br /> Page 3 of 4 <br />