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Agreement to Conduct Permitting by Electronic Means <br /> Name of permittee representative desiring to ��J <br /> opt in to ePermit: Oft V'I'U C re-sS 12 <br /> Title: <br /> I-f-s L Ck--h t- <br /> Name of permittee: Octe _/ cre,;--dc col-kStyl ch,a� <br /> Signature: <br /> ePermitting Administrator (if different from <br /> representative signing agreement) <br /> Email Address for ePermit Account: <br /> Notarized Affidavit of Signature <br /> CASEY F/WRING <br /> NOTARY PUBLIC <br /> STATE OF: � ) STATE OF COLORADO <br /> n r0.f1(� NOTARY ID 20144009652 <br /> COUNTY OF: ) ss. <br /> MY COMMISSION EXPIRES FEBRUARY 28,2018 <br /> The foregoing instrument was acknowledged <br /> before me this 2Z day of n ov ?0 I Le by <br /> (date) (month) (year) <br /> as <br /> (Name of permittee representative) (title <br /> of OC� <br /> (permittee) <br /> hr� <br /> NOTAkY PUBLI <br /> (seal) <br /> My Commission expires: <br /> 6Z-7 S - IDS <br /> Page 3 of 6 <br />