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, CITY OF EVERETT <br /> ; <br /> GAS PIPING T�ST AFFIDAVIT <br /> ;� � � � <br /> Homeowner J—��- � d.- "'<<��F`4 i,�v"�"vGU <br /> Address yr���J �/ i�]�% G✓Lv1 fklL Permit No. <br /> The gas piping system was tested at l� Psi ior a tctal of�_minutes. <br /> WITNESSED BY ���<-' �l��l-4`c L - CarvrR�Tv2 _J I <br /> (si n ure f occupant esting gas service) (date <br /> � ��� �� <br /> INSTALLED B yJ � <br /> 'n a as itt ( ate <br /> Please arrange f r someone to be resent on the dnte of requested inspection to provide <br /> access for the i spector. <br /> , <br /> `�,, Hard Copy - Job Site Pink Copy - Contractor White Copy - Inspector <br />