Laserfiche WebLink
4iLCITY OF EVERETT <br />/ GAS PIPING TEST AFFIDAVIT <br />Homeowner ,�l0.1-k ZJ <br />Address - % z X -y0y <br />The gas piping system was tested at I_j __psi for a total of— minutes. <br />WITNESSED BY / IM <br />(signatur . upant requesting gas service) date <br />INSTALLED BY --8' f� elL <br />(signs a of installing gas fitter) (date) <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 />