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� <br />,, <br />CITY OF EVERETT <br />GAS PIPING TEST AFFIDAVIY <br />� <br />Address /�iy� ��(�j�ll✓� 14-Jc PermitNo.M 6 d��DoiQ <br />The gas piping system was tested at_ %� .Dsi for a total of�_minutes. <br />WITNESSED BY <br />INSTALLED BY <br />re or occupa <br />re <br />yas <br />_� <br />gas <br />��� <br />(date <br />yJ/ �, <br />(date <br />Please arrange for someone to be present on the date of requested inspeation to provide <br />access for the inspector. <br />Hard Copy - Job Site Pink Copy - Contractor Whlte Copy - Inspector <br />