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Agreement to Conduct Permitting by Electronic Means <br /> Name of permittee representative desiring to <br /> opt in to ePermit: <br /> Name of permittee: <br /> Title: <br /> Signature: LQ� <br /> Email Address for ePermit Account: - <br /> 6-a_lvon y met; M <br /> Notarized Affidavit of Si2nature <br /> STATE OF.- <br /> COUNTY OF: ) ss. <br /> The foregoing instrument was acknowledged <br /> before me this Jr tA day of Zd�b <br /> (date) (year) <br /> as <br /> P.o.� <br /> (Name of permit ee representative) (title) <br /> of <br /> (permittee) <br /> OTARY PUBLIC <br /> JOHNIE ABAD <br /> seal NOTARY PUBLIC <br /> (seal) STATE OF COLORADO <br /> My Commission expires: NOTARY ID 20084020977 <br /> W COMMISSION EXPIRES JUNE 16,2020 <br /> Page 3 of 4 <br />