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\Agreement to Conduct Permitting by Electronic Means REC'erVeo <br /> FEB 762017 <br /> 2017 <br /> aViQ,y OF <br /> Name of permittee representative desiring to opt in to ePermit: �a <br /> Title: W e- o ra!,b r <br /> Name of permittee: 0" f <br /> Signature: <br /> ePermitting Administrator(if different from <br /> representative signing agreement) <br /> Email Address for ePermit Account: a m ah d Ood e.c e(, m S n.co y-,- <br /> Notarized Affidavit of Signature <br /> STATE OF: n ) <br /> COUNTY OF: � ) ss. <br /> C i ��� <br /> The foregoing instrument was acknowledged <br /> before me this I L1 day of Ft� by <br /> (date) (month) (year) <br /> as <br /> (Name of permittee representative) (title) <br /> of <br /> V �st g looter✓ (�,,�,. <br /> (permittee) <br /> 2�� �� <br /> NOTARY PUBLIC <br /> (seal) PAULINA MEDRANO <br /> M Commission expires: Notary Public-Arizona <br /> Y p Pima County <br /> My Comm.Expires Oct 2,2018 <br /> Page 3 of 6 <br />