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\ ����n �� <br /> F�o o�?000 � <br /> CITY OF EVERETTC/TY aF <br /> GAS PIPING TEST �4FFIDAVIf"" SBryEe�rr <br /> Homeowner�G ����..�___ __ <br /> Address� � G� ���_ PermitNo. GOO �039 <br /> The gas piping system was tested at �G� psi for a total ol�U minutes. <br /> WITNESSED 8Y - �� � <br /> nature ot occupant reques y gas service) (date <br /> INST��LLED BY ��//.i[�?! —� L� �� � •2 f o0 <br /> (signature of installing gas filter) (date} <br /> Plcase arrange for someonz to be present on lhe date of requested inapection to provide <br /> access for the inspector. <br /> � Hard Copy - Job Site Pink Copy - Contractor White Copy - I��spEctor <br />