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CITY OF EVERETT <br />GAS PIPING TEST AFFIDAVIT <br />ItNo.!L�11 <br />The gas piping system was tested at I for a total of1_minutes. <br />WITNESSED <br />INSTALLED <br />BY/T*/(� <br />tun o occupa request n gas s.ry T (dots) <br />of S_ .n <br />(signature o Installing gas er ate <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 />