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. i c t <br /> Duct Seal Affidavit <br /> Company ��N� s �/� License tt �` � ����� <br /> Address `���� �!/�iU� permit# /� + `�'� <br /> �`�1��!5 , �� i �✓�S�Z- <br /> I ��,v �d 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 dud sealing at the above <br /> referenced address has been completed in accordance with all applicable codes and standards. <br /> _�1 <br /> Cont�actors Name(printed) <�'�-U�� v ��`'` Date � �J ��" <br /> Signature <br />