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.... <br /> CITY O� EVERETT <br /> Homeowner � G�IPING TEST AFFIDAVIT <br /> �9��. � /��� <br /> Address� �$ ( i�p��, Permit No. � � <br /> The gas piping system was tested at�psi for a total of /, J minutes. <br /> �—�--- <br /> WITNESSED BY Cah-� ` /��n� � oB o0 <br /> (signature of occupant requesting gas service) (date <br /> INSTALLED BY <br /> (s' ture of i stal i g gas fitter) �date � <br /> Please arrange for some ne 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 />