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1/26/2021 Annual Report ePermitting Signup-Google Forms <br /> Please complete this form to create a new ePermitting account for submittal of annual <br /> reports and fees. You will receive an email with your login information within two business <br /> days. This form is for new ePermitting account activation. If you have already enrolled in <br /> ePermitting, you should not complete this form. <br /> Name of Permittee or NOI Holder: <br /> Willow Creek Mine <br /> Street Address: <br /> 32460 Inverness Dr. <br /> ................................................................................................................................................................................ <br /> l <br /> City: * <br /> Evergreen <br /> State: <br /> Co <br /> ................................................................................................................................................................................ <br /> Zip: * <br /> 80439 <br /> Telephone: <br /> 303-929-3303 <br /> ................................................................................................................................................................................ <br /> https://docs.google.com/forms/d/1 lrxOW3YTBhUgGtgfeXDsK5GkvVjw_jFE-9jmiKZURFs/edit?urlBuilderpomain=state.co.us#response=ACYDBNhuG... 2/4 <br />