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Agreement to Conduct Permitting by Electronic Means <br /> Name of permittee representative desiring to �� J <br /> opt in to ePermit: 1 -0 <br /> Title: {�/ <br /> Name of permittee: ,7 �� ���\ I ���,�ch k pi +jr u <br /> Signature: <br /> ePermitting Administrator(if different from <br /> representative signing agreement) <br /> Email Address for ePermit Account: /^on Ir&t I /IQ SZ yti hoo c o ,- <br /> Notarized Affidavit of Signature <br /> STATE OF: ) <br /> C�1or�y <br /> COUNTY OF: ) ss. <br /> ra�ai�c� <br /> The foregoing instrument was acknowledged <br /> before me this �--V " day of by <br /> (date) (month) (year) <br /> — as <br /> �Kn�( <br /> (Name of permittee repres ntative) (title) <br /> of <br /> 0,.(-)f1A,t m IM G\o ,mar 1� PLC_ <br /> (permittee) <br /> LUCIA TERRIQUEZ <br /> NOTARY PUBLIC NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 20144000136 <br /> MY COMMISSION EXPIRES JANUARY 2,2018 <br /> (seal) <br /> My Commission expires: <br /> Page 3 of 6 <br />