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'-q�{�(��pj�r�pr <br /> ;;�:.� '-S a, <br /> �'r <br /> ia� <br /> Duct Seal Affidavit <br /> Company A 1�({TCCH � _2U'� {'S o� P,"'�}SC,c� License# �A��/�/.,�c�y�_ <br /> Address �U• ►�ia� �'ra('� Permit# / J �O�I <br /> �-�i�N�/�N1 / ��•3r,�� <br /> �5�+��e lp3�o 1 ��-Sf <br /> -ZC I°N Y�1-�I LLS F(• 3�S�t�. <br /> I���(�p5{�j.f�(j�LPm�2�.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 compieted in accordance with all applicable codes and standards. <br /> Contractors Name(printed) (�,{�c��-I.p� � .�(1�(.,,ern�;2.� Date Nd f! �,a'�ZG/Z <br /> Signature . <br />