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., .. . � . ....: .,, .. .. c. . _._ _�. '_. . �+.,,+�e.w.ca_c..can�i�:.. ,.:u.v .. � -_... .... . . .1 <br /> � je <br /> `�! <br /> CITY OF EVERETT <br /> GAS PIPING TEST AFFIDAVIT <br /> Homeo er �Pvl►1�S � � r��LtC <br /> Address �In �V1C1a n0�13 flVe �tJ�IP�. �� q�2(�Permit No. 41A 0002.-0�3 <br /> The gas piping system was tested at !S psi (or a total of /Zo minut�s. <br /> Fl�/�t Q.onnecTiaits ���{ w�� T/l'��bA ��sCSAK.�fL�'asK. <br /> WITNESSED BY 1��-�--1 l. � 1�---•-� . _J a�O LO� <br /> (signature of occupant requestmg gas service) (date <br /> INSTALLED BY n�s��...OoG.r�t �?� � <br /> (signature of inst�a ing gas fitter) (da� <br /> Please arrange for someone to be present on the date of requested inspection to provide <br /> access tor the in:t aector. <br /> . Hard Copy - Job Site Pink Copy - Contractor Whfte Copy - Inspector <br />