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SNOHOMISH COUNN PLANNING & DEVELOPNIENT SERVICES <br /> GAS 'IPING TEST AFFIDAVIT <br /> Homaowner L N �G(' � i�1,�7�1 <br /> Address ���� G/c ��✓l4 r S/�G!''7 �i, _ Permit No. <br /> ihe gas piping system was tested at _�(Z____ psi for a total of _,__�� minutes. <br /> I WITNESSED BY �..�,�.� �i�.:L.�i — — -- lo / ��� � �y <br /> (s�gnoture ol occunant ien���s��,c�pns ser�ce> (date) <br /> INSTALLED BY �' � <br /> - --- ��/� <br /> gnatuie of inslaWng��n:tnFq (date) <br /> Please arrange for someone to be present on ihe date of requesTed inspection to provide access <br /> for the inspector, The white copy must be mailed to Snohomish County Planning & Developmenf <br /> Services, M/S # 604, 3000 Rockefeller Avenue, Everett WA 98201-4046 upon completion. <br /> Hard Copy-Job Site Pink Copy- Coniractor White Copy- Mail <br /> ilfYvV1 16U�107 <br />