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��� <br />��x <br />C H <br />�Hti <br />y�H <br />FG C� <br />H� <br />"�� H '�J <br />CA H <br />L�1 O LTl <br />H C7 <br />OH <br />��g <br />�j] V �% <br />9H� <br />y <br />t H H <br />gN <br />H <br />e]G� <br />��h7 <br />z H fn <br />HOf/� <br />R',_'_^'_,._.__.-._.__.-.-.-__--_-._-...�_....�-.�-- . . ._--._--.--.--_—�__ T—_.._ <br />� _ <br />GAS PIPING T�ST AFFIDAVIT <br />Homeowner -> r OTI Ja,n� I S <br />s Address %% l �j �.ow Pv' K/dqe. ;i c�.. Permit No. �ti� ._3� �/,� <br />, The gas piping system was tested at �-� psi for a total of %--� minutes. <br />0 <br />_ ,:� <br />�.� -_ r "- <br />WITNESSED By . �.' •.a+ , � �, 't , -- � --- <br />(signature of occupant requesting <br />INSTALLED BY i�;^'� ` r Ilto, r�:�1r_,c��t �/ <br />(signature of installing gas fitl <br />gas <br />� <br />,�� �z <br />(date <br />�� �� <br />(date <br />•��,�lease arrange for someone to be present on the date of requested inspection to provide <br />access"for the inspector. The white copy must be mailed to Snohomish County Community <br />De��elopment, 4th Floor, Administratio� Bldg., Everett, WA 98201 upon completion. <br />Hard Copy - Job Site <br />S co•�o� <br />Pink Copy - Contractor White Copy - Mail <br />