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t <br /> !` i J <br /> • S I� <br /> t„ <br /> Duct Seal Affidavit <br /> Company 1�S ��/� License# ��`/ C � ��" � <br /> Address_ � , � o r, ti Permit# 3 � <br /> '� `�� � �,a _ <br /> �� � � �� r � <br /> I ���� d �v �N ffiant,hereby affirm that t am the duly licensed contractor of record for the above <br /> referenced pe�mit,that al f the forgoing information is true and accurate,and that the duct sealing at the above <br /> referenced address has been completed in accordance with all applicable codes and standards. <br /> Contractors Name(printed) l O� W. i a. 5-r� Date � ' �� � r � <br /> ` /J <br /> Signature � <br />