2016-10-24_GENERAL DOCUMENTS - M1977053

• Permit No: M1977053
• IBM Index Class Name: General Documents
• Doc Date: 10/24/2016
• Doc Name: Agreement to Conduct Permitting by Electronic Means
• From: Asphalt Constructors, Inc.
• To: DRMS
• Email Name: THM
• Media Type: D
• Archive: No

Agreement to Conduct Permitling by Electronic Means
Name of permittee representative desiring to
opt in to ePermit:
Title:
Name of permittee:
Signature:
ePermitting Administrator (if different from
representative signing agreement)
I'.mail Address for ePermit Account:
l�res�c�en�
VS C
Notarized Affidavit of Signature
STATE OF: )
Col 0jo _
COUNTY OF: )
The foregoing instrument was acknowledged
before me this I
(date)
as
ss.
TO&A 0. SAzC1W0fa.I��
(Name of permittee representative)
TIFFANY HAWKINS
NOTARY PUBLIC, STATE OF COLORADO
My Comm- Expires 12/15/2016
(sea 1)
My Commission expires:
day of ()(,-%bQ r 0 by
(month) (year)
(title)
of
hO,.�- ' CG s N—uc-tys 1 nc
(Perrbittee) !�
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