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- { �-- -- .----� <br /> � ` r <br /> PROPANE GAS <br /> � � AND AIC ir�c. <br /> ���� %y�� 8 i 3-782-5013 <br /> ��-�1 ��_�1��1 Roac�-- /����17}rl�ilis. �-�L >;��1 <br /> DUCT SEAL AFFIDAVIT <br /> �-- , <br /> Job Name �QI'�'1 BS Q-1 � License # CAC043948 <br /> Address ���� �'3�e� � Permit# C.�T� `/��3� <br /> �-h,��s , �� . ��s�2. <br /> Phone /�13 - 7�� - /�!'�g'.� <br /> r--- <br /> I, �L°-IJ//L� J �tf�? , affiant, herby affirm that I am the dully licensed <br /> contractor of record for the above referenced permit, that all of the forgoing information is true <br /> and accurate, and that the duct sealing at the above referenced address has been completed in <br /> accordance with all appliance codes and standards with: <br /> ❑ Mastic Tape ❑ Mastic <br /> Contractor's N e rinted ��°v/� v <br /> (p ) �✓�9�f-2 Date S"zq" /3 <br /> �, <br /> Signature <br />