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12/4/2017 Annual Report ePermitting Signup - Google Forms <br />https://docs.google.com/forms/d/1lrxOW3YTBhUqGtqfeXDsK5GkvVjw_jFE-9jmiKZURFs/edit#response=ACYDBNiGAx_VZcJgpAltfY-HZIdPKOW6LB-…2/4 <br />314 State Hwy 10 <br />Walsenburg <br />Colorado <br />81089 <br />719-738-1883 <br />M-2017-019, M-2010-032, M-2009-027 <br />Vezzani <br />Street Address: * <br />City: * <br />State: * <br />Zip: * <br />Telephone: * <br />Permit/NOI Numbers (ie M-1987-189, P-2016-026): <br />Last Name of individual who will act as account administrator for the <br />ePermitting account: *