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Agreement to Conduct Permitting by Electronic Means <br /> Name of permittee representative desiring to <br /> opt in to ePermit: (D/7yz6#0 ax/,� <br /> Title: smeblu <br /> Name of permittee: C�rl=!2 CL W. C2f7 Un 1117 L; <br /> Signature: &W6&2 <br /> ePermitting Administrator(if different from L <br /> representative signing agreement) <br /> Email Address for ePermit Account: <br /> Notarized Affidavit of Signature <br /> STATE OF: ) <br /> COUNTY OF: l � ) ss. <br /> CPaSG <br /> The foregoing instrument was acknowledged <br /> before me this r-�-a day of nU USA by <br /> (date) (month) (year) <br /> as <br /> (Name of permittee representative) (title) <br /> of <br /> C/21-/cte?n <br /> (permittee) <br /> SUSAN GATES <br /> � NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 20144011444 NOTARY PUBLIC <br /> "COMMISSION EXPIRES AAARCH 12,201S <br /> (seal) <br /> My Commission expires: <br /> Page 3 of 6 <br />