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_..� ( �G__ � �.."� <br /> � '� �� PROPANE GAS <br /> � � AND AIC �HC. <br /> ���'��' %��'L} 8 i 3-782-50 i 3 <br /> ��4�1 'rl��n ':oaci - /_�.:}�h�rhills, FI, �;5�1 <br /> DUCT SEAL AFFIDAVIT <br /> Job Name ��l/�/N � <br /> Lic�nsc � CAC043�4a <br /> Address � g o/ � e��/� �-� Permit# � ��l� <br /> ��I� ��s, �� , - <br /> 3����- <br /> Phone J � � " ��� - ���� <br /> . <br /> I• �1>/ `/ , affiant, herby affirm that I am the dully licensed <br /> contractor of record for the above referenced permit, that all of the fargoing 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 Name (printed) �°(J//l� �/ ��-�j'a Date <br /> Signature � � <br />