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10/31/22,5:45 PM ePermitting Administrator Change Form <br /> ePermit Number: <br /> 414309 <br /> ......................................................................................................................................................................................................................................................................................................................................................... <br /> Last Name of individual who will act as account administrator for the ePermitting account: <br /> Brisch <br /> First Name of individual who will act as account administrator for the ePermitting account: <br /> Jeremy <br /> ........................................................................................................................................................................................................................................................................................................................................................ <br /> Email address of account administrator: * <br /> The account administrator is responsible for providing the Division with a current email address for <br /> ePermitting correspondence. Please contact the Division if an existing administrator email requires <br /> updating. <br /> jeremy.brisch@costillacounty-co.gov <br /> ........................................................................................................................................................................................................................................................................................................................................................ <br /> Telephone: * <br /> 719-298-2079 <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 /> Jeremy Brisch <br /> https://docs.google.com/forms/d/1 QY6C6w2BMyQoAmu1_DFtS5wVHlfoeUraQePxvehJJac/edit#response=ACYDBNiMZxI_Wp3y1 U6-01 FOuv9RZ1 yj... 2/3 <br />