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� __�-- -: <br /> � � � AND�A/CGAS <br /> c. <br /> L�"���� �`��� s�3-7s2-so�3 <br /> -�-�-+; ��i1�r14:��a�� � /.c��I��i�hills. I L ;;;�1 <br /> UUC'T SEAL AFFIDAVIT <br /> Job Name � � �� � <br /> ___ _ _ _ . __ I.icense # CAC04i94X <br /> --- <br /> Address cP�' 2,� �� �Uc��, /� � <br /> --------- _ Vi4 KS i R Permit # �5��� <br /> -- - ---- <br /> _ _ ____ <br /> �h��H,_u 5 � __.T� .�3s�-z, <br /> Phone c�f/3-�f18-�oy�7 <br /> - __--------------�-__ <br /> � <br /> 1' £ ��__���� _, affiant. he►•by aftirrn that 1 am the ciully licei�sed <br /> contractor of record I�or the above relerenced permit, that all of the fiorgoing intormation is true <br /> and accurate, and that the duct sralin� at the above reterenced address Ilas been �ompleted in <br /> accordance with all appliance codes and standards with: <br /> L��'Mastic "I�ape C�}�stic <br /> Contractor"s N ame (pri nted) �f V/,✓ �A�/� �— /y� y <br /> ------- Date <br /> _ __ ___-- / <br /> Signature __ �(�=_--._ <br />