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_- ,�..� -� .�,_�,- <br /> CITY OF EVERETT <br /> GAS RIPING TEST AFFIDAVIT <br /> Homeowner �4 IU �-K,i `- L- C— _ <br /> Address � �v ZS ��t�� L�(�^,_.(,rn Permit No. 7I1 GL/�4 `�' �/�j/ <br /> / <br /> The gas piping system was tested at____�'�_psi for a total ot�_minutes. <br /> WITNESSED BY � ���� <br /> (s re of occupan e ting gaa service) (date <br /> INSTALLED 9Y ' � ' I��� <br /> signature of ins all gas fitter) (date <br /> Please arrange for sc;meone to be present on the date of requested inspection to provide <br /> access for the inspecto�. <br /> ' Hard Copy - Job Site Pink Copy - Contractor White Copy - Inspector <br />