Laserfiche WebLink
• - ' - .,�'�` �, '-_;;��:.=-� �,�,.�, <br /> . -_ :..-;:a�.:�.m�, �.��3� ;'j;r C i�4 c . <br /> .v� �..T�,B�-5�� ,.� <br /> ,� , <br /> - .. :; . . . , <br /> DL1CT SEAL AFFIDAVIT <br /> .tob Name ���✓C � s�.' �� , , l�icense# CAC'043948_ <br /> Address �y,�� �S�V< ���� �2 Permit# __ _ <br /> _ _2_^�/ /�.s � 3.s�y . <br /> , <br /> - --- . . <br /> Phone g�.� — /� � 7— � / � ' <br /> I, �� v� %✓ � �`I���_. affian _ herby affirm that� I am the dull� licensed <br /> contractor of record f=or the ahove referenced permit, that all of the forgoin� informatu�n ls h-ue <br /> and accurate. and that tht duct sealing at the bc�ve referenced address has been uompleted �n <br /> accordance with al] appliance ce�deti and sta�tdaid� with: <br /> �Iastic I ape �!J Mastic <br /> i <br /> C.'ontractor�s Name (printed) , �� V� � v` ���2-_ 1)ate �/z /y <br /> � Signature <br /> ---�--- - ---- ---- <br />