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CITY OF EVERETT <br />GAS PIPING TEST AFFIDAVIT <br />Homeowner /a Permit No.� <br />minutes. <br />Address / �" psi or a total of� <br />The gas Piping system was tested at <br />W;TNESSED BY <br />INSTALLED BY (s gnatun o nstalling g1w1••ww vide <br />Please arrange for someone to be present on the date of requested inspection to pro <br />access for the inspector. <br />White Cppy - Inspector <br />` Hard Copy -Job Site <br />Pink COPY - Contractor <br />