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Agreement to Conduct Permitting by Electronic Means <br /> Name of permittee representative desiring to H <br /> opt in to ePermit: Ed w�'n VA u-j <br /> Name of permittee: � <br /> Title: U r�h Wn^.�-vv�.p-�. �n °v,.c,�✓ <br /> Signature: <br /> Email Address for ePermit Account: EOLA VMLES ( �C— _ corn <br /> Notarized Affidavit of Signature <br /> STATE OF: Cb G ) <br /> COUNTY OF: PLA eb 10 ) ss. <br /> The foregoing instrument was acknowledged before me this 2� day of A tt 1- , 2-C,/ by <br /> _ )) (date) (year) <br /> EdwiN NvcareS as <br /> (Name of permittee representative) (title) <br /> of <br /> c-,,CC �iC7 6YC�nc�e, nC <br /> (permittee) <br /> JACKNotary <br /> SERNA <br /> Notar NOT Y PUBLICy Public <br /> State of Colorado <br /> Notary ID 20144042744 <br /> Commission Expires Nov 4, 2018 <br /> (seal) <br /> My Commission expires: <br /> Page 3 of 4 <br />