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CITY OF EVERETT <br /> GAS PIPING TEST AFFIDAVIT <br /> Hom�own�r � �33 C' l9Di �/ <br /> Addnss ���1 �� Ptrmit No��3 - 6�� <br /> The p�s pipinp syst� n w�t bsttd N e 7 pd for� totd of -�p minutes. <br /> WITNESSED 8Y <br /> s pnatun o occup�nt nqu�st no p�s s�rv • �t� <br /> INSTALLEDBY�—�,2--=— �.l� 0/d,d�..v /Yn�i�.lal.� �� � <br /> (s pn�tun o friita np �as tta �t� <br /> Please �rranp� for iom�om to b� pro��nt on th� dat� of nqu��tRd Insp�ctMn to provide <br /> acceas for the insp�ctor. <br /> Hard Copy - Job Sit� Plnk Copy - Contnctor WhN� Copy • Inepector I <br /> � <br />