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CITY OF EVERETT <br /> GAS PIPING TFST �+►FFIDAVIT <br /> Homeowner C/kCiIAID $QUA E E�'r <br /> Addresa � C Permit No.��n��3_�2� <br /> The pas piping ayatem was tested at � ai for a total of � � minutes. <br /> . (� '� 1�.1� <br /> WITNESSED BY L a;IIA .� 2;( ,� �� <br /> s pnature o occupant r queatinp pas service) (date <br /> n <br /> INSTALLED BY !s l���...�. �/� v� <br /> (signatureo stalling pas fitter) (date <br /> Ptease arrenge for someone to be present on the date of requested inspcctfon to provide <br /> access for the inspector. <br /> Hard Copy - Job Sfte Pink Copy - Contractor White Copy - Inspector <br />