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CITY OF EVERETT <br />� G�1S PIPING TEST AFFIDAVIT <br />Homeowner ��� �� ''SA`.1�t <br />Address q �O 5 E FJF1.f-tc M�C. w� Permit No. o�a��"��Y <br />� <br />The gas piping system was tested at�_Pg� for a total of�minutes, <br />WITNESSED BY <br />nature of occup <br />Ir�STALLED BY <br />gaa <br />ng gas fitter) <br />��� � � <br />(date <br />� date �— <br />t�iease arrange (or someone to be present on the date of requested inspection to provide <br />,,ccess for the inspector. <br />� <br />', Hard Copy - Job Site Pink Copy - Contractor White Copy - Inspector <br />