2008-10-15_REVISION - M1999120

• Permit No: M1999120
• IBM Index Class Name: REVISION
• Doc Date: 10/15/2008
• Doc Name: Adequacy Review Responses and Extension Request
• From: L.G. Everist, Inc.
• To: DRMS
• Type & Sequence: TR3
• Email Name: ECS
• Media Type: D
• Archive: No

The notarized signatures of the Structure Owner Representative and the Applicant
Representative confirm the Agreement between the parties and the repair/compensation
obligation of the Applicant as stated above.
IN WIT SS HEREOF, the parties have executed this Agreement effective as of the
c?` _ day of? , 2004.
Agreed by the Applicant:
Signature of Representative for L. G. Everist, Inc.
L. G. EVERIST, INC.
--?q"
Date
1 " *,% rLe I'dA V• P.
7•? 1 1 • J • a °y1^. ____
Name and Title (please print)
State of Colorado )
)ss
)
County of a?A, 5
e forego' g instrument was acknowledged before me on this o?4 day of
2004, by the signatory Representative above. Witness my hand and
official seal,
Notary
My Commission Expires.
FL-LBDCAgreementSep2004.DOC 10
MY QXM* fon Expires Jan. 22, 1006