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C1TY OF EVERETT <br /> GAS PIPING TEST AFFIDAVIT <br /> Homeowner �.- � �id .� � U <�, �, � y � r �� � i%�� °� � : � — <br /> ; > <br /> � 1 <. l� <br /> Address t , ,� << � <_ �-���' h ',N. A � ; � : %, .Permit No. � �% <br /> The gas piping systern was tested at i�� psi for a total of (�' minutes. <br /> f <br /> WITNESSED BY ��-.' ' ''•' � �date ,_a. <br /> (signature , f occupant r�questing gas service► ( <br /> : <br /> INSTALL�D 8Y f � ��`i3i1 -- ---- --_._ _ lQ GZ � <br /> �`(signature of installing gas fitter) (date <br /> Please arrange for someone to be present on the date of requested inspection to provide <br /> ;,ccess for the inspector. <br /> Hard Copy - <br /> Job Site Pink Copy - Contractor `� White Copy - InsPectc►' <br />