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�--- <br />Homeowner � f <br />Add <br />CITY O� EVERETT <br />GAS PIPING TEST AFFIDAVIT <br />No.N�n�; -c'JO�� <br />The gaa piping syatem was iested at i5 � bs psi tor s total of�minutes. <br />/ ' <br />WITNESSED BY � '�-L-� -�— � <br />�A-r "� <br />(sjqnature occupant re uestinp y�sfervice) (date <br />:� <br />INSTALLED BY_ <br />ature <br />gas <br />��� � <br />(date <br />Please ar�ange for someone to 6e present on the dete ot requested inspection to provide <br />access for 1he inspector. <br />Hard Copy - Job �ite Pink Copy - Contractor White Copy - Inspector <br />