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..t.. <br /> CITY O� EVERETT <br /> GA�IPING TEST AFFIDAVIT <br /> Homeowner ��v/ Q � �� �^� — Q/ <br /> Address ���` Permit No. � / <br /> The gas piping system was tested at�Ps� for a total of�L�minutes. <br /> WITNESSED BY �� `�°k'"'�'''" � aB o0 <br /> (signature of occupant request�ng gas service) (date <br /> INSTALLED BY �date � <br /> (s' ture of i stal i g gas frtter) � <br /> Please arrange for some ne to be present on the date of requested inspection to provide <br /> access for the inspector. <br /> Pink Co Contractor White Copy - Is�spector <br /> Hard Copy - Job Site pY ' <br />