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8/11/255 11:31 AM ePermitting Sign-up for New Applications and Annual Reporting <br /> Currently held Permit/N01 Numbers (ie M1987189, P2016026) <br /> M 1981309 <br /> ........................................................................................................................................... <br /> Last Name of individual who will act as account administrator for the ePermitting account: <br /> KING <br /> _............................................................................................................................................................................ <br /> First Name of individual who will act as account administrator for the ePermitting account: <br /> MASON <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 /> MKING@a PLAINSTEL.COM <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 /> _............................................................................................................................................................................ <br /> Email address(es) of additional person(s) to notify on annual report/map/fee due date(s): <br /> _............................................................................................................................................................................ <br /> https://docs.google.com/forms/d/1 IrxOW3YTBhUgGtgfeXDsK5GkvVjw_jFE-9jmiKZURFs/edit#response=ACYDBNj5FcuU3hYowNG4pjeCsgVz5crv8sq... 3/4 <br />