Laserfiche WebLink
Agreement to Conduct Permitting by Electronic Means <br />Name ofpermittee representative desiring to <br />opt in to cPermit: <br />Title: / l - l ,�ec elG? r <br />Name of permittee: / <br />Signature: <br />ePermitting Administrator (if different from <br />representative signing agreement) <br />Email Address for ePermit Account: <br />Notarized Affidavit_ of Signature <br />STATE OF: ) <br />Ctiti orr,kao <br />COUNTY OF: bud a e,v,- T ss. <br />The foregoing instrument was acknowledged <br />before me this 1'Z) day of�QN�t <br />by <br />(date) (year) <br />a5 ��Ce �r� end- Secve <br />(Name of permittee representative) (title) <br />LORENA MEOINA <br />Notary Public - State of Colorado <br />Notary 10 20164032814 <br />My Commission Expires Sep 22, 2020 <br />(seal) <br />My Commission expires: <br />of�$ S -to n 2 1 <br />(permittee) <br />iv <br />Y PUBLIC <br />Page 3 of 6 <br />