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CITY OF EVERETT <br /> GAS PIPING TEST AFFIpqV�T <br /> Homeowner <br /> �-r (; � <br /> Address�_�?. - �� � -- <br /> l,� `1 < %,. ;;1 .-ll�,� f� , ;�,' � <br /> The gas '., ;' , I;�i� r� --_ <br /> p�p��9 syatem ►Mas tested at � Permit No. /��� `=�� <br /> ---�Psi for a total of <br /> —�►ninutes. <br /> WITNE55ED BY .-' <br /> (S�gnatu�e ot occu / � I� � y ` " ' <br /> ^ pant requesting gas service) V � � <br /> �� , ,, . <br /> INSTALLED BY_S� / � , (date —� <br /> rP�� r' <br /> (s�gnatu of i stalli ��� <br /> Please arran 98$ [tter) <br /> access for thee�spec�o�orie to be present on the date of re (date <br /> quested inspeetio� to proy�de <br /> Hard Copy . �ob Site <br /> Pink Copy - Contractor <br /> Whl�e COPy - Inspector <br />