Laserfiche WebLink
� <br />� <br />� <br />owner <br />CITY OF EVERETT <br />GAS PIPING TEST AFFIDAVIT <br />--� <br />f <br />Nome -� / <br />Address �' � � � � � �� u % Permit No:�_%�.L_��� <br />The �as.piping system was tested at �O psi for a total of � � minutes. <br />('�-cr=�i,���2�'ri��vy L,/yY5 � ;��5j--���5 /�- �'/y��S <br />WITNESSED BY <br />nature ot o�cupa <br />gas <br />� date <br />INSTALLED BY � — � � `�jl S <br />signature of installing gas fitter) �date <br />Piease arrange for someohe to be pre�sent 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 />