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� <br />� <br />CITY OF EVERETT <br />GAS PIPING TEST AFFIDAVIT <br />Homeowner v <br />Address_ ��_ l�O�-�-/1c�/ �L'P pL.. PermitNo.�/d5 � <br />The gas piping system was tested at�Pg� for a total of�minutes. <br />WITNESSEO BY <br />INSTALLED BY <br />�� o� <br />(date <br />(date � <br />Please arrange for 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 />