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SNOHOMISH COUNN PLANNING & DEVELOPMENT SERVICES <br /> GAS PIPING TEST AFFIDAVIT <br /> Homeowner / �9DU� ti S ,� ! �e � <br /> Address � 2`�� y � �.�J /�✓C Permit No, <br /> fie gas �Iping system was tested at /t ps; for a total of3� minutes. <br /> r 2'�'�-'-� ���,--- 1 Zl oz <br /> , WITNESSED BY _ ��— <br /> (9pn r of c requestkip pas seMce) (tlate) <br /> INSTALLED BY �� 02-- <br /> c ,�oi x�s+oiiu,o oa�nne�� caa�e> <br /> Please arrange for someone to be present on ihe date of requested inspectfon to provide access <br /> for the inspector. The white copy must be mailed to Snohomish County Planning & Development <br /> Services, M/S # 604, 3000 Rockefelle� Avenue, Everett WA 98201-4046 up��n completion. <br /> , <br /> Hord Copy-Job Sffe Pink Copy-Contractor Whtte Copy •Mdl <br /> � IIN51:� IQU�107 <br />