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CITY O� EVERETT <br /> GAS PIPING TEST AFFIDAVIT <br /> Homeowner��Ar �-�C.� ��"�'�(LSo� <br /> Address 7'�rl �-6 -P �,� . Permi! No. D —O(8 <br /> The gas piping system was tested at�_psi for a totaf of_�_minutes. <br /> WITNESSED BY � �9 / D� <br /> ture of ccup nt requesting gaa service (date �—� <br /> INSTALLED BY � V v�M�_ _ ��� <br /> (signature of instali ng gas fitter) (date <br /> Please arrange (or someone to be present on the date of requested inspection to provide <br /> access for the inspector. <br /> Hard Copy - Job Site Pink Copy - Contractor White Copy - Inspector <br />