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.t <br /> *""�P E! t:i,; <br /> . >4� ,i ` /'# <br /> Duct Seal Affidavit <br /> . � <br /> n � , � � / y 3 <br /> Company (✓ �� � ��i� S ���Cn�d r��0/�l J� License�t v� �� � / <br /> l <br /> � ; � <br /> � �39 � I �� R��� C� <br /> Address z ����' � �l�' � � 3sL� f 3 9� � <br /> Permit# <br /> I � � �� � / <br /> � 6 � � � <br /> � P � � ,�r� U� <br /> Z- � �� � �� I ( �� 335� � <br /> , <br /> I��M°��i� —� 0/I �l4 affiant,hereby affirm that I am the duly licensed contractor of record for the above <br /> reference 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 appiicable codes and standards. <br /> Cont�actors Name(priMed) M � ` 0 n ��� Date � � �� —� 3 <br /> ► <br /> Signature`�� r � ��Y��'�' <br /> � State of ���O rt��,, $ <br /> �� County ot ►.ul ' ��; <br /> t, On this day of �n I • � <br /> b e perso�ally,app ared <br /> t', <br /> to me known to e the person who executed the <br /> � foregoing instru ent,and acknowledged that he <br /> : <br /> ° execute he s e as his free act a deed. <br /> SEAL(sig d) - <br /> � aLIC <br /> c .. . Q e.,I., nl,t•if: ,_ .L„w .. <br />