2017-01-10_GENERAL DOCUMENTS - M1981107 ‎(9)‎

• Permit No: M1981107
• IBM Index Class Name: General Documents
• Doc Date: 1/10/2017
• Doc Name: Agreement to Conduct Permitting by Electronic Means
• From: DRMS
• To: ELB Stone, Inc.
• Email Name: AME
• Email Name: SLB
• Media Type: D
• Archive: No

Agi-eeme►rt to Conduct Permitting by Electronic Means
Name of permittee representative desiring to
opt in to ePermit:
Title:
Name of permittee:
Signature:
ePermitting Administrator (if different from
representative signing agreement)
Email Address for ePermit Account:
Notarized Affidavit of Signature
STATE OF: )
COUNTY OF: ) ss.
The foregoing instrument was acknowledged
before me this day of by
(date) (month) (year)
as
(Name of permittee representative)
(seal)
My Commission expires:
C>iI
(title)
(permittee)
Page 3 of 6
NOTARY PUBLIC