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CITY OF EVERETT <br /> GAS PIPING TEST AFFIDAVIT <br /> Homeowner�� . o � �J vc-,(j <br /> Addresa lL��6 Z � /�� �J' �Gi , Permit No. COaI�i�/� <br /> The gas piping syatem was tested at�_psI for a tohl of�_minutes. <br /> � �' _� <br /> WITNESSED BY � <br /> (s�ign re occ te estinp gai service) (date <br /> INSTALLED BY �) `� ' �Z S� U� <br /> (aignatur f stallinq qas titter) (date <br /> Please arrange for someon� to be present on the date of requeated inspection to pravide <br /> access for the inspector. <br /> Hard Copy - Job Site Pink Copy - Contractor White Copy - Inspector <br />