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� <br />� <br />� <br />Hom�owner <br />A <br />CITl' OF EVER�TT <br />, <br />TEST AFFIDAVIT <br />it No. � /o � �C.� <br />The gas pipin system was tested at 5��% psi for a total of � a a._minutes. <br />;� � �-�N1�5 <br />WITNESSED 8Y <br />INSTALLED BY <br />occupant requesting gas <br />� �E,z�za <br />na re of installing gas fitter) <br />� <br />rvice) (date � <br />y-Zs'—�/ <br />L..,�i r�'��� <br />(date <br />Please arrange for someone to be present on the date of requested inspection to provide <br />accessfortheinspector, <br />Hard Copy - Job Site Pink Copy - Contractor White Copy - Inspector �� � <br />�J <br />