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Y� �eo b )CQ �)� <br /> Agreement to Conduct Permitting by Electronic Means <br /> Name of permittee representative desiring to <br /> opt in to ePermit: <br /> Title: j ovi <br /> Name of permittee: L C <br /> Signature: <br /> ePermitting Administrator(if different from <br /> representative signing agreement) <br /> Email Address for ePermit Account: <br /> Notarized Affidavit of Signature <br /> SARAH KELLY BOLTON <br /> STATE OF: <br /> NOTARY PUBLIC <br /> �� �� ) STATE OF COL ORADO <br /> NOTARY ID 20164027910 <br /> COUNTY OF: ) ss• MY COMMISSION EXPIRES JULY 22,2020 <br /> The foregoing instrument was acknowledged <br /> before me this day of by <br /> 4_ ec)v PG r (date) (month) (year) <br /> AL as <br /> (Name of permittee r resentative) (title <br /> „'P. of <br /> ' LE ec �- <br /> SARAH KELLY BOLTON (pe tee) <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 20164027910 <br /> MY COMMISSION EXPIRES JULY 22,2020 NOTARY PUBLIC <br /> (seal) <br /> My Commission expires: r� <br /> Page 3 of 6 <br />