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� <br /> CITY OF EVERETT ' <br /> GAS PIPING TEST AFFIDAVIT <br /> Homeowner �'�,� S� CO���—`7 <br /> Addrees �� °� GL����01� f�✓� Permit No.�n la� boZ <br /> r � <br /> The gas piping system was t�sted at �� psi for a total of � 7 minutes. <br /> WITNESSED BY� �I/ I.1L. <br /> (signature occupant reGuesti s aervice) (date <br /> � �INSTALLED BY <br /> (signature of ins � �ng g itter �(date <br /> Please a�range for someone to be present on the date of requested inspection to provide <br /> access for the inspector. <br /> Hard Copy - Job Site Pink Copy - Contractor White Copy - Inspector <br />