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Agreement to Conduct Permitting by Electronic Means <br />Name of permittee representative desiring to <br />opt in to ePermit: <br />Title: <br />Name of permittee: <br />Signature: <br />ePermitting Administrator (if different from <br />representative signing agreement) <br />Email Address for ePermit Account: <br />'ee r hQ, t..01 /-? 47us/ - <br />See= <br />�.4 a <br />Notarized Affidavit of Signature <br />STATE OF: ) <br />COUNTY OF: ) <br />The foregoing instrument was acknowledged <br />before me this <br />(date) <br />5s. <br />day of bc\-W , by <br />(month) (year) <br />as <br />�L'a%"%iQ'�17 �r !✓i%S'/e%� ��C/��PfGiI"Y./ <br />(Name of permittee representative) (title) <br />of <br />HEATHER K LOEB <br />NOTARY PUBLIC <br />STATE OF COLORADO <br />NOTARY ID 20ISM268 <br />WCOMMISSION WIRES AUGUST 05, 2019 <br />(seal) <br />My Commission expires: <br />It <br />d5l , <br />Page 3 of 6 <br />1 <br />�� � / �� w�►� mit <br />