2018-08-03_REVISION - M1997039

• Permit No: M1997039
• IBM Index Class Name: REVISION
• Doc Date: 8/3/2018
• Doc Name: Application
• From: Wyatt/High Country
• To: DRMS
• Type & Sequence: SO1
• Email Name: PSH
• Media Type: D
• Archive: No

NOTARY FOR STRUCTURE OWNER
ACKNOWLEGED BY:
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Structure Owner < < 5�-r r1, , Name -A p(. (
Date (� � Y Title 0 k)vt e C
STATE OF Ct)1(.c cgj v )
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COUNTY OF 1-4 )
The foregoing was acknowled ed before me this day of f, 201� , by
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My Commission Expires: 1T�2 Z
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DERWOODtate of Colorado094039637pires Dec 4,2021