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�r.°ry1�9"�'zl�f�* <br /> -_�';*,.'�.el�.1'%6�1;. . <br /> •:J '`f�• <br /> ,�r� <br /> `L���p� - <br /> S�. <br /> k'� <br /> Duct Seal Affidavit <br /> Company�'l(�E`�� Q-5 ��(' �. �(,� License# ,� {O � <br /> Address,���°3 4 ��/�`�j h��� � Permit#t / ' <br /> � D{7U[��1 �l� S , l�� <br /> �� � �� <br /> � /`'l� ( � affiant, her�y 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 /> �7 . <br /> Contractors Idame(printed)�"�'_'—` � Date_����/ � <br /> Signature � � <br /> Z d LS69-Sb9-LZL 6uiuoilipuo��iy s,ouew <br />