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Agreement to Conduct Permitting by Electronic Means <br /> Name of permittee representative desiring to <br /> opt in to ePermit: <br /> Title: <br /> Name of permittee: rr <br /> Signature: <br /> ePermitting Administrator(if different from <br /> representative signing agreement) <br /> Email Address for ePermit Account: <br /> Notarized Affidavit of Signature <br /> STATE OF: raAa ) <br /> COUNTY OF: W ) ss. <br /> The foregoing instrument was acknowledged <br /> before me this 4-W day of �P� nt 2Oar , Z O J'7 by <br /> (date) (month) (year) <br /> I as <br /> 0.r k Lev i ►1 �res►ct v n <br /> (Name of permittee representative) (title) <br /> of <br /> d u+t 6 6 L 50 U,rr-tvS_ KC' <br /> (permittee) <br /> NOT Y PUBLIC <br /> (seal) JHARI L. SANDER <br /> My Commission expires: NOTARY PUBLIC <br /> STATE COLORAD <br /> 28 - 20 NOTARYOID 2 0044028624 <br /> My Commission Expires Sept.28,2020 <br /> Page 3 of 6 <br />