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6/4/25, 11:06 AM ePermitting Sign up for New Applications and Annual Reporting <br /> Street Address: <br /> 122 Antelope Road <br /> ............................................................................................................................................................................. <br /> City: * <br /> Leadville <br /> State: <br /> CO <br /> ............................................................................................................................................................................. <br /> Zip: * <br /> 80461 <br /> Telephone: <br /> 719-293-4908 <br /> Currently held Permit/N01 Numbers (ie M1987189, P2016026) <br /> P2024007 <br /> ............................................................................................................................................................................. <br /> Last Name of individual who will act as account administrator for the ePermitting account: <br /> Martinez <br /> https://docs.google.com/forms/d/l lrxOW3YTBhUgGtgfeXDsK5GkvVjw_jFE-9jmiKZURFs/edit#response=ACYDBNjOfXk2gmL9BHTAgJOHaVbcvOoV6... 2/4 <br />