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CITY OF EVERETT <br /> GAS PIPING TEST AFFInAVIT <br /> Homeowner /�•� � l� � Ll 1? /= T �HF. �i/F y <br /> Addross � 00�( �.�jJl� � r� P�rmltNo. '�iDo/2 "o�Pj „ <br /> The q�s plpinp sysbm wu testtd �t �� psi for�tohl of ��/ minutes. i <br /> `�i <br /> WITNESSED BY �G/A��—_��' ����` � � 2O'°�� <br /> s n�t e occup�nt h u�st n 0�� s�rv c� ate <br /> INSTALLED BY �-- 1 <br /> � ���� .��� . <br /> � • pn�tun o n ta np p�s �r ate <br /> Please arranq� for�omeone to b� pns�nt on th�d�H of nqut�t�d Inap�ctlon to provfde <br /> access for the Insp�ctor. <br /> Herd Copy - Job Slt� Pink Copy • Contnctor WhIN Copy - Inspector <br />