2019-03-15_REVISION - M1983035

• Permit No: M1983035
• IBM Index Class Name: REVISION
• Doc Date: 3/15/2019
• Doc Name: Application
• From: Schmidt Construction
• To: DRMS
• Type & Sequence: SO2
• Email Name: TC1
• Email Name: MAC
• Media Type: D
• Archive: No

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NOTARY FOR STRUCTU7 OWNER
ACKNOWLEDGED BY:
Structure Owner e „j� a�r c� Name
(Print o6ces Name) ( er's signature)
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Date I I �-I I Title Cam. \-j
(Enter either Owner if Private or Representative Title)
STATE OF COLORADO )
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COUNTY OF EL PASO }
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The foregoing was acknowledged before me this_Z_day of J�p f , 2018, by
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My Commission Expires: 0 Z
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