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. <br /> � <br /> ;';. {� <br /> Duct Seal Affidavit <br /> /�►�/� r r <br /> Company 1✓ 110/1/� �l �./1 � .�r��° '' `� �IC'u� �(; License# C A C;�� S�t 7 �3 � <br /> � C� 3 � 1{ �� P/) ,�n 6 t� C ���? y ; l-�! II? �Ci ��`?( <br /> ,���/� Address G ' �` � � l l �� Permit# � / <br /> , _}_. <br /> 5� 1 �� � ,� ��� 5��e � � <br /> Z ��ti �, : � ; J�� F1o�, ��% 3 3>�<� <br /> ���^fi��? �(r /"1�'���ffiant,hereby affirm that I am the duly licensed contractor of record for the above <br /> referenced permit,that all of the fo�going 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 /> r <br /> Contractors Name(printed) 1 I�'�' n?� � ! �'' /�vl,/) r Date V� � ���� <br /> / <br /> Signature <br /> �� <br /> + � . <br /> / � �f� <br /> `�( ( � C, <br /> v � � . <br /> � . <br />