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Agreement to Conduct Permitting by Electronic Means <br />Name of permittee representative desiring to <br />opt in to ePermit: S U -,C <br />Title: <br />Name of permittee: <br />Signature: <br />ePermitting Administrator (if different from <br />representative signing agreement) <br />Email Address for ePermit Account: r <br />-Le- d <br />Notarized Affidavit of Signature <br />STATE OF: 010 � ov �x A L2) <br />COUNTY OF: ) ss. <br />The foregoing instrument was acknowledged <br />before me this day of D. C I by <br />(date) (month) (year) <br />J0 Z(A Yl V1�� LJUI mo^ a5 6Z <br />(Name of permittee representative) (title) <br />CATHERINE S. ACORD <br />NOTARY PUBLIC <br />STATE OF COLORADO <br />MY CotulJYll ARE FIRES S��BER 19, 20 0 <br />(seal) <br />My Commission expires: <br />- q i I I ),acgo <br />of <br />Ul- to u Y -i �n'i Y, Rork, <br />(permittee) <br />Page 3 of 6 <br />NOTARY PUBLIC <br />