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Agreement to Conduct Permitting by Electronic Means <br />Name of permittee representative desiring to �ys-c" <br />Sopt in to ePermit. <br />Title: t 1qfZ_ �AI�J- EIZ <br />Name of permittee - <br />Signature: <br />ePermitting Administrator (if different fron <br />representative signing agreement) <br />Email Address for ePermit Account: <br />STATE OF: <br />Notarized Affidavit of Signature <br />COUNTY OF: ) ss. <br />O <br />The foregoing instrument was ac nowledged <br />before me this I day of <br />(date) <br />_�)10fmbcr, _�nj by <br />(month) (year) <br />as <br />M 161010 L. fir- Wit- i mbe-r- M o -n e ` <br />(Name of permittee representative) (title) <br />of Eviler" P_51,n,5 L- Q <br />(permittee) <br />DAWN KORRELL <br />NOTARY PUBLIC <br />STATE OF COLORADO <br />NOTARY ID 20114081311 NOTARY PUBLIC <br />COMMISSION EXPIRES DEC. 29, 2019 <br />(seal) <br />My Commission expires: <br />l� <br />Page 3 of 6 <br />