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i1 <br /> �`�( �� ��?�PANE GAS <br /> �,�„ ��� A/C �!vc. <br /> ,°—�—.. <br /> � �� �-�'82-501 � <br /> � , , r ' ;;�j <br /> DUCT SEAL AFFIDAVIT <br /> Job Name qdv� ,�iLoo,C�' License # CAC043'�48 <br /> Address 6 �{ 5��2 F,,,��'��� �2 Permit# �7 _T� _ <br /> � ,���1 f�L— ��'t'` o� ����i/llS <br /> _���� � <br /> Phone_ O �= /6� "��/s <br /> I, /r �.v"-'�- �,I��P/�2 , affiant, herby affirm that I am tr�e dully licensed <br /> contractor of record for the above referenced permit, that all of the forgoing i�nformation is true <br /> and accurate, and that the duct sealing at the above referenced address has �een completed in <br /> accordance with all appliance codes and standards with. <br /> ll�'Mastic "I'ape � Mastic <br /> Contractor's Name (printed _ ��!ff,e :S' �j2o,o�iri�'G�.se.��� Date �2��-� <br /> Signature <br />