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\ <br /> CITY OF EVEREf T <br /> GAS PIPING TEST AFFIDAVIT <br /> Homeowner �'GrK2,on/ <br /> Address l�0 2 � � Permit No. �Jd ody3 <br /> ., 30 <br /> The gas piping ayst was tested /� asi for a total ef__=�i ut.� es_ <br /> � <br /> WlTNESS B _�_I <br /> n ure ccupant requeating gas service) (date) <br /> INSTALLED BY .�.�.�..�.7`� � D ,�,� <br /> (signature of installing gas fitter) (date <br /> Please arrange for someone to be present on:�he date of requeated inspection to provide <br /> access for the inspectar. =-s:: <br /> • Hard Copy - Job Site Pink Copy - Contractor White Copy - znspeccor <br />