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� � � � PROPANE GAS <br /> � AND A/C tn�c <br /> �'rcE� �488 8 i 3-782-5013 <br /> -1-�-1 i �;;�11 1Zc�a.j /�E,i��i�h��i,. 1 l ;;;-�1 <br /> DtiCT SEAL AFFtDAVIT <br /> Job Name C���(�e�W _ I,icense # C'AC'0���)48 <br /> Address _� 74?cP /��'P�nJ�Gc10t�� Perrl�it # / 7� /A <br /> - - -- � _� ___ __���`��{ <br /> � � <br /> -- - -�_p�--� o�at---33��� <br /> Phone O ��°' �g�" �� /� <br /> 1, c,('�U//� J�1/��/e__ _____ . affiant. herby aftirm that 1 am the at►uy licensed <br /> contractor of record ior the ab<��c rcterenced permit, that all of the tor�o�ng intormation is tru� <br /> and accurate, and that the duct sealin� at the ahove rctcrenced address has heen cc�mpleted �n <br /> accordance with all applianc� codes and standards with• <br /> L� Mast�c 'I ape Mastic <br /> Contractor�s Name (pi-inleci) - �� '�. I.��il/ ��9/�� Date _� ��s <br /> Signature <br /> ���r— _-------_.�-- -- -- -- <br />