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I ` � <br /> � <br /> r �� �' '^' �'v:�?�N� �6�..�..... <br /> ,�. .�:� '�a:":. t�d'�� !NC. <br /> �......_�.....�._._.�,��.._. <br /> � wF`, 5 �..�(JG.-S� p � <br /> DL1C7�' SEAL 4FFIDAVIT <br /> .loh Name /� � 2� �/d � ��� I,icense # C�AC'043948 <br /> Address � � (1 � -� /��J�oi't- �jZ-- Permit# l ��`�� <br /> Phcme ��� " �.� � � 770� <br /> 1- � �u i ��t/ ����� . affiant_ herby affirm that [ am the dull�� licensed <br /> contractor ufi record t-or th� ahove referenced }�ermit, that all of the for�oing infiormatii>n i� true <br /> and accurate. and that the duct sealing at the ah���e referenced address has been c��mpleted in <br /> accordance with all appliance cudes and standard� with: <br /> stic �I�apc �astic <br /> � <br /> ('ontractor-� Namt (print�cl i ��1�i2 ..S' ��r�,�y� �.S(? � I)ate �—Z ���� <br /> �ignature � '--- <br />