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, P� <br /> �� �. y,� �ti 1,j� • <br /> I ��r <br /> Duct Seal Affidavit <br /> � <br /> Company ��S� �f�w��0�- License# �� �2� ��d �' <br /> Address 33�/b �U S�,QE,r-- ��- �/-�- Permit# � 5 G 5 � <br /> 5-E. . ��.��s lo�� F( 3��7 l � <br /> �.le ►4��.� '. /�-� ����� <br /> � -��1�r 'i �r� �r� <br /> z�����"�l� S �L 33 S� Z <br /> n �-� <br /> � 1` S 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 /> ) � 1 m ������ Date <br /> Contractors Name(printed � �-' —� �� <br /> �r S{�4I1 v��--�� !��o,�.t_ <br /> v — <br /> Signature =�:l-�— �` <br /> v"" <br />