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CITY OF EVERETT � <br /> GAS PIPING TEST AFFIDAVIT <br /> Homeowner M���'� '�� U ��N� <br /> �- <br /> Address $� �L �i '�Z2��� t7� Permit No. ��2o�i-- vo� <br /> � — <br /> The gas piping system was tested at �`� psi for a total of�_minutes. <br /> � <br /> WITNESSED BY � .C���`•��`��'�'t,,� _J <br /> (signature of occupant requesting gas service) (date <br /> INSTALLED BY <br /> (signature of installing gas fitter) (dats <br /> Please arrange for someone to be present on the date of requested inspection to provide <br /> access for the inspector. ��` <br /> � <br /> Hard Copy - Job Site Pink Copy - Contractor White Copy - Inspector <br />