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CITY OF EVERETT <br /> GAS PIPING TEST AFFIDAVIT <br /> Homeowner ` "`���"� L r\�� `^ <br /> � '� �n �.V,��.._t.f PermitNo�OI��=U�� <br /> Address ZZ-U � �-q ti f' � r• � / ` <br /> psi for a total of�_minutes. <br /> The gas piping system was tested at �_� <br /> �� �� /L � b �/ <br /> WITNESSED BY date <br /> (signature of occupant requeatinq �as service) ( <br /> INSTALLED BY -� ��s� G / ���— <br /> (s' atu e of installing qas fitter) (date <br /> Piease arrange for 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 />