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, _ � (�,�: .. r.. . � <br /> CITY OF EVERETT qpR _ 9199g r, <br /> ...... <br /> GAS R1i�iNG TEST' AFFIDAVIT ;���;ej oAU�ER�TT <br /> , <br /> Homeowner '.- _.. .�'�,:r �: �1 /L+= _ l'�t-1 L °"� Sery,�es <br /> r �1 '1�� <br /> Address � ' � _[��4 '-n .� /� V� Permit No. <br /> The gas piping system was teated at � � ' Dsi for a total of �-G' minutes. <br /> � <br /> r '-`\ � , <br /> \ ) � <br /> WITNESSED BY ,�`���� ,��i��� �' — � � �--�- <br /> (siynature of oc upant r�questinp �as serv�ce) (date <br /> �c3��,s _ �-f�C��t :-�� r�,�� �, s,s. �,� � <br /> � • , ,� ,� .. <br /> INSTALLED BY� /�-� _ � /`�'�����'�Z —J� �' <br /> (signature o installmp gas fitter) (date <br /> Please arrange for someone to be preaent on the date of requeated inapection to provide <br /> access for the inspector. <br /> Hard Copy - Job Site Pink Copy - Contractor White Copy - �nspector <br />