2013-04-09_REVISION - M1977215 ‎(4)‎

• Permit No: M1977215
• IBM Index Class Name: REVISION
• Doc Date: 4/9/2013
• Doc Name: SUBMITTAL OF COMPLETENESS ITEMS
• From: OPERATOR
• To: DRMS
• Type & Sequence: AM1
• Email Name: RCO
• Media Type: D
• Archive: No

ACKNOWLEGED BY: Cad
Structure Owner Ci 1 -} l of C �G� t
Date £ t s) d 24, 2612
STATE OF
COUNTY OF
CD )
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S t o tLk as
NOTARY FOR STRUCTURE OWNER
Name 5z)."!
Title /a4/d // Atli_
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The foregoing was acknowledged before me this e(uday of , 20 12, by
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My Commission Expires: C ( \.(t 5