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`v <br /> ;, <br /> CITY OF EVERETT <br /> GAS PIPING TEST AFFIDAVIT <br /> Homeowner .�7'e � ��GGv-(� �/ <br /> Address // ��-G L� ��� b��sON �� Permit No�')DC}�S 10 � � <br /> The gas piping system was tested at ( � asi for a total of zD minutes. <br /> '• /1 <br /> � WITNESSED BY � /t /3 � -�� ��3/ �U <br /> (signature of occu nt requesting gas service) (date} <br /> INSTALLED BY � •�'�c.'�"" F �`�� — -��_�/O <br /> (signature of installing gas fitter) (date <br /> Please arrange for someone to be pres�nt on the date of r�qu�sted inspection to provide <br /> access for the inspector, <br /> Hard Copy - Job Sita Pink Copy - Contractor White Copy - �nspector <br />