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�� �ti <br /> y ���''�I �' �f;'�PANE GA�� <br /> :�- <br /> ' a�„�;� A/C �MC. <br /> �� �-�82-501� <br /> . , r . , , ' ;;;� � <br /> DUCT SEAL AFFIDAVIT <br /> Job Name �ol�i✓_�p£S�� License # CAC043'948 <br /> Address �� 3 3l__��/_C�L yjoTvS�� Permit# ___ <br /> -- / <br /> i ��� �.✓oe�f7 `i��.,c� .S <br /> Z� 1 ,- , ��_ _ �� �.�.5'f'� <br /> Phone_��3 '— 7$ C� � ��1.�� <br /> I. fiant, 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 /> �Iastic "I,ape �-lviastic <br /> Contractor's Name (printed) � v.''vv �, ,C� �0 �/� Date �� �8_�� <br /> Signature _ <br />