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Agreement to Conduct Permitting by Electronic Means <br /> Name of permittee representative desiring to <br /> opt in to ePermit: bfty i fl CX-t?SS tfy- <br /> Title: <br /> l7 I,t1"Y1PX <br /> Name of permittee: \"�A.V iCk L tIUM <br /> Signature: <br /> ePermitting Administrator(if different from <br /> representative signing agreement) <br /> Email Address for ePermit Account: O JO C I �-ILLuf '�"�� • Ylf <br /> Notarized Affidavit of Signature <br /> STATE OF:Cacmk ) 6UqY FAHRING <br /> NOTARY PUBLIC <br /> COUNTY OF: ) ss. STATE OF COLORADO <br /> (Y 6-15 NOTARY ID 2014400902 <br /> MY COMMISSION EXPIRES FEBRUARY 28,2018 <br /> The foregoing instrument was acknowledged <br /> before me this (0 day of �p C _ , f-7 by <br /> (date) (month) (year) <br /> as <br /> (Name of permittee representative) (title) <br /> of &-'2o ��� <br /> (permittee) <br /> 06kk-j <br /> 1T,t i!n <br /> NOT AY PUB <br /> (seal) <br /> My Commission expires: <br /> 02-Zs-1Fs <br /> Page 3 of 6 <br />