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Agreement to Conduct Permitting by Electronic Means <br /> Name of permittee representative desiring to <br /> opt in to ePermit: Pj` <br /> Title: <br /> Qresi JE.n+ <br /> Name of permittee: <br /> Signature: <br /> ePermitting Administrator(if different from <br /> representative signing agreement) <br /> Email Address for ePermit Account: � ' 75.1,E A? &e-n i a t, t e rke+ <br /> Notarized Affidavit of Signature <br /> STATE OF: ) <br /> COUNTY OF: ) ss. <br /> Cc.tit-C�_ <br /> The foregoing instrument was 6&nowledged <br /> before me this Z 16 day-of LmemkUil, ZO 1 by <br /> (date) (month) (year) <br /> as <br /> e5; + <br /> (Name of permittee representative) (title) <br /> of <br /> (permitt e) <br /> ANN V. CAFFEY <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID#2014404 1193 I n <br /> EMISSION EXPIRES NOVEMBER 07,2018 <br /> NOTARY PUBLIC <br /> (seal) <br /> My Commission expires: <br /> l� 1-7 l <br /> Page 3 of 6 <br />