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Homeowner <br />2- <br />- <br />CITY OF EVERETT <br />GAS PIPINjP TEST AFFIDAVIT <br />The gas piping system was <br />WITNESSED BN <br />INSTALLED BY <br />f- <br />�'- Permit No. <br />at_, ,psi for a total of�_minutes. <br />� <br />(date <br />(date) <br />M <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 />