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w <br /> O <br /> �, fl� <br /> Duct Seal Affidavit <br /> Company l�- ` License# � f�) 1� ���Q <br /> Address���� Pe�mit# � � � ���� <br /> � t� ,, � <br /> �-P I _ C �5 ( � <br /> � affiant,hereby affirm that I am the duly licensed contractor of record for the above <br /> referenced permit,that all of 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) r ` � <br /> Date �� �� <br /> Signature / <br />