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CITY OF EVERETT <br /> GAS PIPING TEST AFFIDAVIT � <br /> Homeowner�C►rT � M�r�on �vvmWiecE-� I <br /> Addresa 4�1 � �I PVl WOC� �vQ . E�2V�t-�permit No.���"�6 <br /> The gas pipin� syatem was teated at ��i ,pai for a total of 2 d minutes. <br /> � , � <br /> WITNESSED B � ����r� O <br /> (si e of occupant reques yas serv ce) (date <br /> INSTALLED BY ���Q <br /> (sipnature of nstalliny yas f tter) (date <br /> Please arrange for someone to be present on the date of roquested inspectfon to provide <br /> access for the inspector. <br /> Hard Copy - Job Site Pink Copy - Contractor White Copy - �nspector <br />