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CITY OF EVERETT <br /> GAS PIPING TEST AFFIDAVIT <br /> Homeowner IV ►'�<<-S � 'v <br /> Address_. L-� ��ES `� 1� FT 1`�l�L�.1-� Permit No. 'S J� <br /> The gas piping system was teated at ��Dsi for a total of �S minutes. <br /> WITNESSED BY jn�%� � ��1/I�An 1�30 98 <br /> (siynature of occupant requestin� yas ser��ce) (date <br /> INSTALLED BY � ��ilts�w` Cc��If�t (� ,30 /� <br /> ��ai nature of installinp gas f ter) (date <br /> �� 7. a�jF�sF�I <br /> Please arrange for someone to be present on the date of requested inspectfon to provide <br /> access for the inspector. <br /> , Hard Copy - Job Site Pink Copy - Contractor White Copy - Inspector <br />