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'J V Agreement to Conduct Permitting by Electronic Means RECEIVED <br /> 15 2016 <br /> t I q N& DVISION OF RE L4WT►pN <br /> Name of permittee representative desiring to <br /> opt in to ePermit: TA�tf `9' <br /> Title: <br /> Name of permittee: f�'����. <br /> Signature: <br /> ePermitting Administrator(if different from <br /> representative signing agreement) <br /> Mark Marhh <br /> Email Address for ePermit Account: <br /> -fin(Oayc. u.s. c6rh <br /> Notarized Affidavit of Signature <br /> STATE OF: ) <br /> COUNTY OF: ) ss. <br /> 5�-- <br /> The foregoing instrt6enIvIas acknowledged <br /> before me this day of by <br /> (date) (month) (year) <br /> as <br /> (Name of ermit ee representative) (title) <br /> of ` <br /> (permittee) <br /> CAROL WRIGHT <br /> NOTARY PUBLIC <br /> STATE OF COLORAD0 <br /> NOTARY ID#20094040322 <br /> MY COMMISSION EXPIRES DECEMBER 09,2017 <br /> NOTARY PUBLIC <br /> (seal) <br /> My Commission expires: <br /> Page 3 of 6 <br />