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Agreement to Conduct Permitting by Electronic Means <br /> Name of permittee representative desiring to �• <br /> opt in to ePermit: 01�, . /./'r� <br /> Title: rs���j�•f <br /> Name of permittee: <br /> �J <br /> Signature: <br /> ZYJ I1�L� ` <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 /> to�c�do <br /> COUNTY OF: } ss. <br /> The foregoing instrument was acknowledged <br /> before me this , day of D�baf- by <br /> (date) (month) (year) <br /> as <br /> L) m m�.I T.`CFI A V- 0y-) P rc sk d Ciy 7 <br /> (Name of permittee representative) (title) <br /> of <br /> (permittee) <br /> LtiOTARY P C <br /> (seal) JENNIFER RIDNOUR <br /> M Commission expires: NOTARY PUBLIC <br /> y xP STATE OF COIORADO <br /> �� (20 -(7 NOTARY ID#20044�38288 <br /> my Comm"im Exp. �o�25�2620 <br /> Page 3 of 6 <br />