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.t.i11'i�Y�j�l.r�R` 'nr1�.Yy.Y�aVY '-iY.: <br /> )y^ 91 f -`i E i�.'� . <br /> t E <br /> � L{ : Y �� ` <br /> A" J <br /> 'Cl�� ti I iyf 2 tI I �:y <br /> � <br /> CITY OF EVERETT <br /> GAS PIPING TEST AFFIDAVIT <br /> Horneowner �� /�� <br /> Address a�]a �p� �lr� Permit No. U CJ —��0 <br /> The gas piping system was tested at��psi for a total o(�c�minutes. <br /> � <br /> WITNESSED BY _�� <br /> (signature of ccupant equestmg a etvice) (date <br /> �� <br /> INSTALLED BY � --��' � L <br /> signat of inst ' gas fitter) �(date O <br /> Please arrange for someone to be present on the date of requested inspection to provide <br /> a�cess for the inspector. <br /> Hard Copy - Job Site Plnk Copy - Contractor White Copy - Inspector <br />