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6/6/23,9:32 AM ePermitting Administrator Change Form <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 N01(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 N01(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 N01(s). This Agreement, including the validity of any signatures or consents, <br /> any claims, or any disputes arising hereunder shall be construed in accordance with and <br /> governed by the Laws of the State of Colorado. Further, if the permit or N01 holder is a <br /> corporation, partnership,trust, etc., you state that you are authorized to act on behalf of the <br /> permittee or N01 holder. <br /> 0 Agree <br /> This form was created inside of State.co.us Executive Branch. <br /> Google Forms <br /> https://docs.google.com/forms/d/1 QY6C6w2BMyQoAmu1_DFtS5wVHI foe UraQePxvehJJac/edit#response=ACYDBNj31ZgvIOslPjaZegTilEIX6GUN17S... 3/3 <br />