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.. � ,..." " �. ., , ..,-,--..:.+m+. +T. .._ . -. . m.u. .. <br />.,.E.AA.YY.'.Pl`s. .C...��.>' . :�..-�..^rcm...v�tir......y �i __�.. . .. . _ �..�.. . �.,....� <br />�:':' . <br />ClTY OF EVERETT <br />GAS PIPING TEST AFFIDAVIT <br />� . ..ncro.avewrr—r.e.m:zsz^M�k.�'/t <br />Homeowne� I V 10.r1�-L '�asc� ��+�-�� � <br />Address _�J�l �7 ��. �'� � P�rmit No.��� 3a 3 03� <br />The gas pipin� systam wss tested at ��.�osf tor a total of�_minutes. <br />WITNESSED BY <br />INSTALLED BY <br />��03 <br />ate <br />� �5 �, <br />ate <br />Piease arran�e for someone to be prosent on the d�te of roqu�ated inspection to provide <br />access for the inapector. <br />� Hard Copy - Job Site Pink Copy - Contnctor White Copy - Inepector <br />