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-� <br /> ____._-----�-�� <br /> _-�....,,,—.-s., <br /> ;: SNOHOMISH COUNN PLANNING & DEVELOPMENT SERVICES ° <br /> � GAS PIPING TEST AFFIDAVIT ;�_ <br /> �,.1. <br /> y Homeowner � ! � <br /> Address '�v� ,v����GJ Permit No, <br /> '� fie gas piping system was tosted at � psl for a total of�_ minutes, .t�� <br /> t � � : <br /> ,.. �/ +='�.y� <br /> �, WITNE�SED BY !����L �-^' f� %� �� ' '� ' ^ <br /> (slpnaturp of occupant requestinp pas seMce) —/�d�� <br /> � —. - . . .. ... .,�_1LJ� <br /> INSTALLED BY �_'� �d�e> <br /> (sipnature of Insta��inQ pas 11tter) � <br /> �� Please aRange for someone to be present on the date of requested inspectlon to provide access � f <br /> . for ihe inspectoc The white copy must be mailed to Snohomish County Planning & Development � <br /> ` Services, M/S � 604, 3000 Rockefeller Avenue, Everett WA 98201-4046 upon completlon. • <br /> , � <br /> tL! � <br /> 'i Hard Copy-Job Site Pink Copy-Contractor WhRe Copy-Mafl ' <br /> , iauim <br />' , nrosin <br />, �_ � -- _. - . _ _ � ' <br />, <br />� <br /> � I i � ._- <br /> #'' � � �� k: - <br /> Ri�:.�'� .� � . =. i�J: <br /> � �• <br /> i� i�l.( , . . . . . <br /> L�.' _; .. _' . . <br /> yj'l.� . . �� , .,1 <br /> 1 "�� I <br /> .�:r I �; <br />; ;�; <br />