2017-08-22_GENERAL DOCUMENTS - M2003002

• Permit No: M2003002
• IBM Index Class Name: General Documents
• Doc Date: 8/22/2017
• Doc Name: Agreement to Conduct Permitting by Electronic Means
• From: HCR High Country Repair
• To: DRMS
• Email Name: ECS
• Email Name: SLB
• Media Type: D
• Archive: No

Agreement to Condttct Permitting by Electronic Means
Name of permittee representative desiring to
opt in to ePermit:
Name of permittee: came S �) , i3l 0L nck
Title: Ujrer
Signature:
Email Address for ePermit Account:
Notarized Affidavit of Signature
STATE OF: )
COUNTY OF: ) ss.
The foregoing instrument was acknowledged
before me this S day of oon by
(date) (year)
�YY�S D as 41.�Jv�r
(Name of permittee representative) (title)
of
MZ-10•bo salidx3 uw - CO) ZD) R
Z06C1009LOZ #
opcJ0103 ;0 9
allQnd Ajejo,
'•' 0'10J d3AINN3r VHSbiVN
(seal)
My Commission expires:
(Permittee)
Page 3 of 4
T Y PUBLIC