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� / ��/ <br /> A �/ f <br /> Q�� � � � � � <br /> rt <br /> rt'�, ,_� <br /> Duct Seal Affidavit <br /> � r � �l C��� l�� /� <br /> , �j <br /> Company '�/ `� �/!�� '�'` � / � `'J� �i� License# �^� �!! � f� � <br /> f � <br /> .� � � '� � ?� � ,� ,�� ,� �; �� <br /> / � � <br /> , �- -�`�'_� y / :�, , ,�� r� L � "�j �j S �( <br /> � •� R� Address Permit# <br /> � � ( `f' t C' <br /> �.�.�� 1 � �r'1�,�, �'P(�,f _ <br /> � �' h i ,�, ,�. �� .� ]� � <br /> � ��� I~ !' � �a�it,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 applicable codes and standards. <br /> Contractors Name(printed) ��''� �� j` �( ?�.�� ' Date �� —� � <br /> Qr �.�____-------_ <br /> tr���:cy of C� S GSD <br /> � J!'�Ytii;�day af Y�CN-�'a o�_� <br /> � befare�rn�pers�nally a�pe�red <br /> � // 1 ��ru o1 a._u��f3Y1 a V f��- <br /> Signature �� ���;,L 6,�own to be t�e;�z<<�an who execu�ed the <br /> - ��_,�;;;:�;nc���strumesit,and acicnowiedged that he <br /> :xc�cayie:�ira��same as his fre�act d. _ <br /> -c�:,:�_(s;y - --- <br /> �LlC <br /> .•`aY P�, CY THIA C EST <br /> �°; ;`�; Notary Public- tate of florida <br /> . " : My Comm.Expires Apr 6.2014 <br /> �=9, o-J;: Commission#DD 979617 <br /> "'•,,e or c��,� <br /> ��,,,,,,,�` Bonded Through National Notary Assn. <br />