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� � � - � <br /> dC1 <br /> `�' � �s����NE G�� <br /> . n,r�� :.�:�a� �!l C ��v c: <br /> _�__.. <br /> �;. = 4��`�82-����, <br /> , , . ,;.. <br /> DLiCT SEA . AFFII)AVIT <br /> .Ioh �iame �Rv� "tJ .��,�'JJf,�Q [,icense # C',f��'0�3948 <br /> Address �/.S� �..,.� n�sT Permit# t 5�`C 7 � <br /> ����y,,�, 1/s �� <br /> 3.�s"Y Z <br /> PhUne �f..S� �/ � —,.�Q �r� <br /> 1. ����„/ ��,q�/� _ attia . herby attirm that I am the dull� I�cen�,�d <br /> contractor ��f i-�cord ti�r th� ahc��e 1-eferenc�d er�mt. that aIl of the for�,oin� intorinat�c�r� �� tt-i�e <br /> and accurate. and that the durt �;ealing at the ahc��e referenced address has been ��c,mpleted �n <br /> acc��rdance with all appl��znct ��>cie� and stand -d� �vith. <br /> �Mastic i a�e astic <br /> — � � � <br /> ('c�ntractt�r�� Name ��rint�c.i, !� � t/f�ytj ,,� ,�� 1)ate � �� /� f <br /> Signature ._ ---- -- -- <br />