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Agreement to Conduct Per-ntittirrg b1,Electronic Means <br /> Name ofpermittee representative desiring to <br /> opt in to ePermit: <br /> Title: <br /> Name of permittcc: <br /> Y d�"f_'Otf/►!'� ��, !1r pa f�i0 �l_yL.D//1t' -: �� , <br /> Signature: <br /> cPermitting Administrator(if different from <br /> representative signing agreement) <br /> Email Address for ePermit Account: 1 <br /> O S 7T"! <br /> Notarized Affidavit of Signature <br /> STATE OF: ) <br /> N•eyc�c�.�n <br /> COUNTY OF: ) ss. <br /> The foregoing instrument was acknowledged <br /> before me this 1b 34N day off' a0� by <br /> (date) (month) (year) <br /> �k_ �� i!`'�� as i <br /> r <br /> (Name ofpernuttcc representative) (tit e) <br /> of ` ' <br /> 7:1 <br /> JESSICA RAUM <br /> 14D Notary Public-State of Nevada <br /> APPT.No. 18-1095-6 My Appt.Expires 12-07-202 UBLIC <br /> (seal) <br /> My Coirunission expires: <br /> Page 3 of 6 <br />