Laserfiche WebLink
Agreement to Conduct Permitting by FIectronie Means <br /> Name of permittee representative desiring to a/\4 <br /> opt in to ePerinit: % iN Cf-4> <br /> Name of permittee: <br /> -� <br /> Title: � <br /> Signature: <br /> Email Address for ePermit Account: <br /> Notarized Affidavit of Signature <br /> STATE OF: Ltd � ) <br /> COUNTY OF: ) ss. <br /> The foregoing instrument was acknowledged <br /> before me this day of by <br /> (date) (year) <br /> A rp ot as <br /> 7Z) <br /> (Name of permittee representative) (tit el ) <br /> of <br /> , -)I M 4� V-' <br /> (permittee) <br /> SHAYA BRANDON <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 20154032669 <br /> MY COMM183ION EXPIRES 08/19/2019 OYAY LIC <br /> (seal) <br /> My Commission expires: <br /> Page 3 of 4 <br />