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CITY OF EVERETT <br /> GAS PIPING TEST AFFIDAVIT <br /> Humeowner 1�'1 � r'r'1�'r Nln��,' S <br /> Address�� L, 6/.��-, Or _Permit No. <br /> The gas pipin� aystem was tested at�psi for a total of�minutes. <br /> ` ��j tc.�.0 `, � ��t�rr'�_ <br /> � WITNESSED BY / �-- _� <br /> (siynature of ccupant requestiny yas service) (date <br /> INSTALLED BY ✓���5 ���� Pl�� �� � �� <br /> (signature of installing gas tter) (date <br /> Please arrange for someone to be present on the date of requested insp:�ction to provide <br /> access for the inspector. <br /> Hard Copy - Job Site Pink Copy - Contractor White Copy - Inspector <br />