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, � ,' <br /> CITY OF EVERETT <br /> GAS PIPING TEST AFFIDAVIT <br /> Homeowner /�-�C �'�'� <br /> Address 22o �1SG� �r� PermitNo�(� 2�005 <br /> The gas piping system was tested at_I h,__Pai for a total of /h minutes. <br /> ✓�.1� � l� �i G <br /> WITNESSED BY date <br /> (signature of occupant requestinp yas serv�ce) ( <br /> � � � — I��CJ� <br /> INSTALLED BY �- � �' `�'� (date <br /> (signature of mstalliRy yas mier� <br /> Please arrange tor someone to be present on the date of requeated inapection to provide <br /> access for the inspector. <br /> Hard Copy - Job Site Pink Copy - Contractor White Copy - Inspector <br />