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Homeowne� <br />Add <br />/� <br />CITY OF EVERETT <br />AS PIPING <br />The gas piping system was tested <br />WITNESSED <br />INSTALLED <br />AFFIDAVIT <br />_,_„Permit No. ��'��'3'"�/% <br />for a total o( minutes. <br />�����a <br />(date <br />,�2F�� .?DDfl <br />(date <br />Please arrange for someone to be present on the date of requested inspection to provide <br />access for the inspector. <br />Fiard Copy - Job Site Pink Copy - Contractor White Copy - Inspector <br />