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Agreement to Conduct Permitting by Electronic Means <br /> Name of permittee representative desiring to <br /> opt in to ePermit: <br /> Title: <br /> Name of permittee: <br /> Signature: <br /> ePermitting Administrator(if different from <br /> representative signing agreement) <br /> Email Address for ePermit Account: <br /> Brian, 1,0�, �t Gsuwtwc�� cokn �p e-lS <br /> Notarized Affidavit of Si ng a <br /> STATE OF: ) <br /> COUNTY OF: , t ) ss. <br /> �Ll ill AI� <br /> The foregoing instrument was acknowledged -/' <br /> before me this day of 1C nL by <br /> (date) (month) (year) <br /> ZOO �— as � <br /> (Name of permittee re sentative) (title) <br /> of <br /> (permittee) <br /> pORIS JENSEN <br /> NOTARY PUBLIC t <br /> G )4-n <br /> STATE OF COLORADO NOTARY P LIC <br /> NOTARY 1D 1996M`I35 <br /> MY COMMISSION EXPIRES JULY 27,2020 <br /> (seal) <br /> My Commission expires: <br /> Page 3 of 6 <br />