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4/4/24,2:53 PM Annual Report ePermitting Signup <br /> Street Address: <br /> 1310 Blake <br /> City: <br /> Wray <br /> State: <br /> Colorado <br /> ............................................................................................................................................................................. <br /> Zip: * <br /> 80758 <br /> Telephone: <br /> 9706303979 <br /> Permit/N01 Numbers (ie M-1987-189, P-2016-026): <br /> ............................................................................................................................................................................. <br /> Last Name of individual who will act as account administrator for the ePermitting account: <br /> Andersen <br /> https://docs.google.com/forms/d/I I rxOW3YTBh UgGtgfeXDsK5GkvVjw_j FE-9j m iKZU RFs/edit#response=ACYD BNj rD-mnVtDBXMh m H037iXXgew5b4... 2/4 <br />