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C�ITY OF EVERETT <br />GAS PIPING TEST AFFIDAVIT <br />hlomeowner�c� L�oy <br />Address � � � Gy���L �� Permit No./%%9`�d8 �3�� <br />Th,e gas piping system was tested at � s psi for a total of� S minutes. <br />�; <br />WITNESSED B� <br />INSTALLED BY <br />1Ll_s li� <br />(date <br />�date � <br />Please arrange for someone to be present on !he date cf requested inspection to provide <br />accr.ss ior the inspector. <br />Hard Copy - Job Sit2 Pink Copy - Contractor Whi4e Copy - Inspector <br />