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8/31/23, 1:51 PM ePermitting Administrator Change Form <br /> Permit/N01 Numbers (ie M-1987-189, P-2016-026): <br /> M1977044, M1980233, M1994103, M199024 <br /> ......................................................................................................................................................................................................................................................................................................................................................... <br /> ePermit Number: <br /> 414309 <br /> Last Name of individual who will act as account administrator for the ePermitting account: <br /> Medina <br /> ......................................................................................................................................................................................................................................................................................................................................................... <br /> First Name of individual who will act as account administrator for the ePermitting account: <br /> Leroy <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 /> leroy.medina@costillacounty-co.gov <br /> Telephone: <br /> 719-936-5958 <br /> ......................................................................................................................................................................................................................................................................................................................................................... <br /> https://docs.google.com/forms/d/1 QY6C6w2BMyQoAmu1_DFtS5wVHIfoeUraQePxvehJJac/edit#response=ACYDBNjzSfOJEKAvMdgeKjUHoZ3tmo5... 2/3 <br />