Fillable Property address, City, State, Zip Code I certify

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Property address, City, State, Zip Code I certify

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Builde
r’s Signature:
_____________________________________
___________
__________________________
___________
__________________________
___________
__________________________
Property address, City, State, Zip Code
____________________
___________________________________________________________________________
I certify that radon resistant construction techniques were used and that the construction meets any local or
state building codes for radon control.
v.1_07/08/19
_______________________________________________________________________________________________
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Property address, City, State, Zip Code I certify

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Completed 22 March 2021

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