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Agreement to Conduct Permitting by Electronic Means <br /> Name of permittee representative desiring to RANDY R/"1 <br /> SS <br /> opt in to ePermit: �..J <br /> Title: OWNER <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 /> opt r I <br /> COUNTY OF: ) ss. <br /> V�a�l h� <br /> The foregoing instrument was acknowledged �� <br /> before me this 13-�• day of M al by <br /> (date) (month (year) <br /> as <br /> OwVt�t�' <br /> (Name of permi tee representative) (title) <br /> of <br /> (permittee) <br /> NDIA_KyPqBLIC <br /> ASHLEY JANECEK <br /> NOTARY PUBLIC-NOTARY SEAL <br /> STATE OF MISSOURI <br /> (seal) COUNTY OF WAYNE <br /> My Commission expires: COMMISSION#16843952 <br /> My Commission Expires:August 2,2020 <br /> g " Z ' ZOZO <br /> Page 3 of 6 <br />