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�. `�,3 f f,i�:. <br /> Duct Seal Affidavit <br /> Company��(r �� � �r-�t��S �,f� f�l�S CG LicenseflCAC 1�S I Cj`{� � <br /> Address_�C>• �'X�x f�� Permit# �' . j � � �� <br /> �� 1��t-F`1{?N �l..1..5 � �( - '���3�1 <br /> �`�'� �'��4 S� �. <br /> -�PN���t��L�S ; �t � ��3S�t�- <br /> � ,�;r Ifc��SNr4'I 5-:�,, affiant, hereby affirm that I am the duly licensed contractor of record for the above <br /> referenced 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 /> Contractors Name(printed)�i���S �j-���Q ,hr�� Date ���— 7' �G/� <br /> � <br /> �, <br /> Signature ' <br />