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Agreement to Conduct Permitting by Electronic Means <br />Name of permittee representative desiring to <br />11�� `i �.. <br />opt into ePermit: C� <br />Ldp <br />Name of permittee: '-"4-f, <br />Title: U <br />Signature: , <br />Email Address for ePermit Account: XFQ <br />Notarized Affidavit of Signature <br />STATE OF: <br />COUNTY OF: ) ss. <br />The foregoing instrument was acknowledged <br />before me this 15 day of 90A by <br />(date) (year) <br />1,,,, ki z)` as <br />(Name of permittee representative) (title) IJ <br />OMAN <br />NOTARY PUBLIC <br />STATE OF COLORADO <br />NOTARY 10 20144017M <br />W COMMI SION EXPIRES APR L 20.2416 <br />(seal) <br />My Commission expires: <br />of � n <br />(permittee) <br />Page 3 of 4 <br />