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5/6/2021 Annual Report ePermitting Change Form-Google Forms <br /> Telephone: <br /> 303-637-8014 <br /> Name(s) and Permit Number(s) of any additional person(s) to notify on annual report/map/fee due <br /> 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 further <br /> consent that you will use ePermit to send any and all correspondence, notices, documents and <br /> information to the Division in all matters related to reports and fees for your Permit(s) and/or <br /> NOI(s). You consent that documents submitted electronically to the Division have the same legal <br /> force and effect as paper documents. The Division reserves the right to send any or all electronic <br /> records to you in paper form to your current mailing address on file at its sole discretion. Your <br /> agreement to opt in to ePermit represents a single legal transaction as that term is used in C.R.S. § <br /> 24-71.3-105. Your agreement to opt into ePermit will become effective immediately upon the <br /> Division's receipt of this signed Agreement and you may no longer receive paper documents from <br /> the Division pertaining to reports and fees for your Permit(s) and/or NOI(s). This Agreement, <br /> including the validity of any signatures or consents, any claims, or any disputes arising hereunder <br /> shall be construed in accordance with and governed by the Laws of the State of Colorado. Further, <br /> if the permit or NOI holder is a corporation, partnership, trust, etc., you state that you are <br /> authorized to act on behalf of the permittee or NOI holder. <br /> 0 Agree <br /> Submitted 516121,3:01 PM <br /> https://docs.google.com/forms/d/1 QY6C6w2BMyQoAmu1_DFtS5wVHlfoeUraQePxvehJJac/edit?urlBuilderpomain=state.co.us#response=ACYDBNh... 3/4 <br />