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� <br /> '�� <br /> CITY OF EN'ERETT <br /> �' GAS PIPING TEST AFFIDAVIT <br /> Homeowner'` R � M �- I < � <br /> � C��� � �� <br /> Address / r -,_� �-.�-� � 4 mn�F �- � �I A-� 'Ju,:`t1 Permit No.�7a70f�' •�X <br /> The gas piping syste was tested at �`7 psi for a total ot z�minutes. <br /> WITNESSED BY J' �'-�,vi.,�, 7 �"� ��� � /; l� , <br /> (signatu�e ot occupant r�qnesting gas service) (date <br /> R�STALLED BY ' . �'�c_ �h�— - - �� l� �'� <br /> ,/ (signature of installing gas frtter) (date <br /> Please arrange for someone to be present on the date o} requested inspection to provide <br /> access tor the inspector. <br /> Hard Copy - Job Site Pink Copy - Contractor White Copy - Inspector <br />