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Agreement to Conduct Permitting by Electronic Means <br /> Name of permittee representative desiring to 9 <br /> opt in to ePermit: �(,c P l �.191,11 50 <br /> Title: <br /> Name of permittee: <br /> Signature: A/14 <br /> ePermitting Administrator(if different from <br /> representative signing agreement) <br /> Email Address for ePermit Account: <br /> Notarized Affidavit of Signature <br /> STATE OF: /� ) <br /> COUNTY OF: ) ss. <br /> _�GN tGZu�l A <br /> The foregoing instrument was acknowledged <br /> before me this day of :,� , b�.T by <br /> (date) (month) (year) <br /> as y�� �1,, <br /> I ' I S C/4tlCl 711 vh��a.y /�"1 14N b cm <br /> (Name of permittee representative) (title) <br /> of <br /> L14 kUtr/ZI? <br /> MARY DEWEESE (permittee) <br /> NOTARY PUBUC <br /> STATE OF COLORADO <br /> NOTARY ID 20084036833` <br /> MY COMM.EXPIRES NOVEMBER 13,2= NOTAR UBLIC <br /> (seal) <br /> My Commission expires: <br /> Page 3 of 6 <br />