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Agreement to Conduct Permitting by Electronic Means <br /> Name of permittee representative desiring to n <br /> opt in to ePermit: Pr", A-I —z <br /> Title: — <br /> U cue �r,C�e.n, <br /> Name of permittee: S L� <br /> Signature: <br /> ePermitting Administrator(if different from j <br /> representative signing agreement) <br /> Email Address for ePermit Account: <br /> Notarized Affidavit of Si nature <br /> STATE OF: <br /> COUNTY OF: ) ss. <br /> .D-elK v,01r <br /> The foregoing instrument was acknowledged <br /> before me this l day of ge, by <br /> (date) (month) (year) <br /> (Name of permittee representative) (title) <br /> of <br /> U) sao I- <br /> (permittee) <br /> EBARBAM.77RIAYBLIC <br /> TARY PUBLIC OF COLORADONOTARY PUBLICY ID 19974013343N EXPIRES DULY 25,2017 <br /> (seal) <br /> My Commission expires: _ <br /> Page 3 of 6 <br />