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{:-,.,. _ . . <br />� � SNOHOMISH COUNTY PLANNING & DEVELOPMENT SERVICES <br /> GAS PIPING TEST AFFIDAVIT <br /> Homeowner R��1K �d r e tia d�A C f J V[f <br /> Address 6y2a C..a Rd _ Permit No. �lt olc2-0�11 <br /> ^ The gas piping system was tested at 1 S psl for a total of �s minutes. <br /> WfTNESSED BY _ ^ ��� �/ <br />� <aaru <br /> c�s �«aue�+rw om�.Mce� <br />� INSTALLED 8V � /�^" N..��,�.,�,. A11c.1j 11d�a, •�1 I.,��dl�� o� <br /> cu�on,�e w w,.��o o��� caor.> <br /> Please arrange for someone to be present on the date of requested Inspecflon to provide accese <br /> for ihe Inspector, The whlte copy musT be malled to Snohomish Counfy Planning & Development <br /> Services, M/S # 604, 3000 Rockefeller Avenue, Everett WA 98201-4046 upon compleflon. <br /> `, Hard CoPY-Job SRe Phk CaPY-Contracta Whl�e CoPY-�Adl <br /> ` imsim <br /> nN��n <br />