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4/12/22,8:40 AM Annual Report ePermitting Signup-Google Forms <br /> Permit/NOI Numbers (ie M-1987-189, P-2016-026): <br /> M-2020-054 <br /> ................................................................................................................................................................................ <br /> Last Name of individual who will act as account administrator for the ePermitting account: <br /> Langenfeld <br /> First Name of individual who will act as account administrator for the ePermitting account: <br /> Benjamin <br /> ................................................................................................................................................................................ <br /> Email address of account administrator: * <br /> The account administrator is responsible for providing the Division with a current email address for ePermitting <br /> correspondence. Please contact the Division if an existing administrator email requires updating. <br /> benl@lewicki.biz <br /> ................................................................................................................................................................................ <br /> Name(s) and Permit Number(s) of any additional person(s) to notify on annual report/map/fee <br /> due date(s): <br /> Dustin Ballard, M-2020-054 <br /> Email address(es) of additional person(s) to notify on annual report/map/fee due date(s): <br /> dustin.advantagex@gmail.com <br /> https://docs.google.com/forms/d/1 IrxOW3YTBhUgGtgfeXDsKSGkvVjw_jFE-9jmiKZURFs/edit#response=ACYDBNiRumBrzoACFSrX5Wr3QOB6Wj87R... 3/4 <br />