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CITY OF EVERETT <br />GAS PIPING TEST AFFIDAVIT <br />li <br />Address_ / �y26 ,�dih��� , ,� ,P {y � f�jolPermit No.71'IDoo/ .��� <br />The gas piping system was tested at_(�_psi for a total of /�_minutes. <br />WITNESSED BY <br />INSTALLED BY <br />�siyn�nre ot occupant requestlnp yas service) <br />J 2� �'� <br />(date <br />� ��Z�� <br />(date <br />Please arrange tor someone to be present on the date of requested inapection to provide <br />access for the inspector. <br />Hard Copy - Job Site Pink Copy - Contractor Wh(te Copy - Inspector <br />