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12/19/2017 Annual Report ePermitting Signup - Google Forms <br />https://docs.google.com/forms/d/1lrxOW3YTBhUqGtqfeXDsK5GkvVjw_jFE-9jmiKZURFs/edit#response=ACYDBNit2CKvoM0UCf-pjYhfyirzOYeAocgP_…2/4 <br />13 West 3rd St Room 208 <br />La Junta <br />Colorado <br />81050 <br />719-383-3035 <br />M-1978-267, M-2004-027 <br />Nichols <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: *