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S;;f�`a'�" 1 .`"�,:�. ��s�'�s:; '�A'4��.A��, F�7X� <br /> � . . . ,. ¢ .. k..� �:;;., .� ._� <br /> CITY OF E4�ERETT <br /> GAS PIPING TEST AFFIDAVIT <br /> Homeowner � .�u-.� � `� / <br /> Address `Y/7 L��cr.s� N,.�., �rM�— "t'd '•3 PermitNo. �6 �` ��� <br /> Tfie gas piping system was tested at�_Pg� for a total of minutes. <br /> � �(.J ' <br /> ..� ___.., y <br /> WITNESSED BY �� �+�-� � ��� �� <br /> (signature of occupant requesting gas service) (date <br /> INSTALLED BY P��l� --�J �' �' <br /> (signature of installing gas fitter) (date <br /> Please arrange for someone to be present cn the date of requested inspection to provide <br /> :,c:cess for the inspector. <br /> Hard Copy - Job Site Pink Copy - Contractor White Copy - Inspector ' �`�1 <br />