Laserfiche WebLink
CITY OF EVERETT <br />%/��� ,G,IIA/S//PIPING TEST AFFIDAVIT <br />Homeowner t.6riCIaZAAL 1�_— <br />Address_ ,Z�1 Permit No. !7�000 3— <br />The gas piping system was tested at psi for a total of_ minutes. <br />Z�4.ed <br />WITNESSED BY '14slJ� ��v <br />(s gnature o occu a requesting gas service) (date <br />INSTALLED BY L�c"t;;; le"n <br />MV <br />(signature of installing gas fitter) �(da e <br />4 <br />'•Please arrange for someone 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 />