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Ore7T CITY OF EVERETT <br /> GAS PIPING TEST AFFIDAVIT <br /> Homeowner— A -- 1 <br /> Address Cid J �— Permit <br /> The gas piping system was tested at _psi for a total of minutes. <br /> WITNESSED BY /11,V, <br /> J� <br /> (signatur of occu ant requesting gas service) (date) <br /> C <br /> INSTALLED BY IJPAzo� -.lti 2,1, <br /> (signature of installing as fitter) (date) <br /> Please arrange for someone to be present on the date of requested inspection to provide <br /> access for the inspector. <br /> Hard Copy - Job Site Pink Copy - Contractor White Copy - Inspector <br />