2018-01-02_REVISION - M1984094 ‎(3)‎

• Permit No: M1984094
• IBM Index Class Name: REVISION
• Doc Date: 1/2/2018
• Doc Name: Application
• From: Playfair
• To: DRMS
• Type & Sequence: SO4
• Email Name: MAC
• Media Type: D
• Archive: No

NOTARY FOR STRUCTURE OWNER
ACKNOWLEGED BY:
(
Structure Owner C DOT Name to
Date -5 1 (O 1 11 Title .
Mar-
STATE OF
)ss.
COUNTY OF )
The foregoing was acknowledged before me this day of 2017,by
V0.�e ri e Su3 and as -?Qery\i t, movia g er of C CX37 P-R ', �-► Z
LI J11 )KOA,'� My Commission Expires: 4
Notary Public
AMBER L BILUNGS
Notary Public • Stab of Colorado
Notary 10 20084013593
My Comniaslon Expires Apr 21,2020