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__ _ _ - . _ _. � __ � <br /> � <br /> CITY OF EVERETT <br /> . GAS PIPING TEST AFFIDAVIT <br /> Homeowner�_-..�.._���f� <br /> Address 2 7�� ���'� cl _���'' Permit No. X�h}� ��a� , <br /> The gas piping syatem was tested at�_Psi for a total ot.�minutes. <br /> • � <br /> WITNESSED BY \ ti,�1��-n � - ��'�fl- _J� <br /> (si�nafu�"e of occupant requ stiny qas service) (date <br /> l ' ��pp <br /> INSTALLED BY ���£ '� ���0 <br /> (signature f installinp yas fitter) (date <br /> Please arrange for someone t e present on the date of requested inspection to provide <br /> access (or the inspector. <br /> Hard Copy - Job Site Pink Copy - Contractor White Copy - Inspector <br />