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CITY O� EVERETT <br /> ��.�'-`vL .�r5"PIPING TEST AFFIDAVIT <br /> Homcowner ���'7/VCr' �Uf}"�-�� �f-fl9C��-- -- <br /> Address_ :jGO� C-� _� l}S�'�7 Permit No. ��v�/��� <br /> The gas piping system was tested at ��`,��_Pgi (or a total of Z� �i minutes. <br /> 1 /� � <br /> , <br /> , -, <br /> WITNESSEDBY ' % i,:,_a � [•. .-/✓ �_..I� . % <br /> (signature t occupant requesting gas serv�ce) (date <br /> R�STALLED BY �JQ1�,� ' n � �" � � S �� � ��J� c)S; <br /> (signature of n a ing titter) (date <br /> �<<"t <br /> Piease arrange (or someone to be present on lhe date af requested inspection to provide <br /> access for the inspector. <br /> Hard Copy - Job Site Pink Copy - Contractor White Copy - Inspector <br />