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CITY OF EVERETT <br /> GAS PIPING TEST AFFIDAVIT <br /> Homeowner,,�' � �� a � � � �n <br /> Adalress�ii s a i.� i � �_�/ ���� 9Ba 90 Permit No.�00/d�D�l <br /> The gas pipinp system was tested at � 7 osi for a total of�_minutes. <br /> WITNESSED BY�___=_�'.rs�:l� ��� <br /> s qneture or occupaQy re u t np �as serv ce) (date <br /> INSTALLEO BY � 1 ��� <br /> (s ynature o al iny �as fitter) (date <br /> Please a�range for someone to be present on the date of roqussted Inspection to provide <br /> access for the inapector. <br /> Hard Copy - Job Site Pfnk Copy - Contractor White Copy - Inspec[or <br />