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2/18/2020 Annual Report ePermitting Change Form-Google Forms <br /> Telephone: <br /> 7196894048 <br /> Name(s) and Permit Number(s) of any additional person(s) to notify on annual report/map/fee <br /> due date(s): <br /> .......... ................................................................................................................................................................................ <br /> Email address(es) of additional person(s) to notify on annual report/map/fee due date(s): <br /> .......... ................................................................................................................................................................................ <br /> By clicking "Agree" below, you opt in to ePermitting for report submittal, and consent that the <br /> Division may send any and all correspondence, notices, documents and information to you <br /> electronically, in all matters related to reports and fees for your Permit(s) and/or NOI(s). You <br /> further consent that you will use ePermit to send any and all correspondence, notices, <br /> documents and information to the Division in all matters related to reports and fees for your <br /> Permit(s) and/or NOI(s). You consent that documents submitted electronically to the Division <br /> have the same legal force and effect as paper documents. The Division reserves the right to <br /> send any or all electronic records to you in paper form to your current mailing address on file at <br /> its sole discretion. Your agreement to opt in to ePermit represents a single legal transaction as <br /> that term is used in C.R.S. § 24-71.3-105. Your agreement to opt into ePermit will become <br /> effective immediately upon the Division's receipt of this signed Agreement and you may no <br /> longer receive paper documents from the Division pertaining to reports and fees for your <br /> Permit(s) and/or NOI(s). This Agreement, including the validity of any signatures or consents, any <br /> claims, or any disputes arising hereunder shall be construed in accordance with and governed <br /> by the Laws of the State of Colorado. Further, if the permit or NOI holder is a corporation, <br /> partnership, trust, etc., you state that you are authorized to act on behalf of the permittee or <br /> NOI holder. <br /> OAgree <br /> Submitted 2118120, 9:39 AM <br /> https://docs.google.com/forms/d/1 QY6C6w2BMyQoAmu1_DFtS5wVHIfoeUraQePxvehJJac/edit#response=ACYDBNh9XtYMejApMIM3YdZnOyQKEY... 3/4 <br />