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, SNOHOMISH COUNTY PLANNING & DEVELOPMENT SERVICES <br />� GAS PIPING TEST AFFIDAVIT <br />Homeowner <br />Address _� ���i K<< i�/1 f/` fi �'P Permit No. <br />The gas pipfng system was tested at /,S psi for a total of 3 S minutes. <br />WITNESSED BY <br />INSTALLED BY <br />(signoture of insfalling gas Attnr) <br />��_LI�QZ <br />.� �� <br />(date) <br />Please arrange for someone to be present on the date of requested inspection to provide access <br />for the inspectoc The white copy must be mailed to Snohomish County Planning & Development <br />Services, M/S # 604, 3000 Rockefeller Avenue, Everett WA 98201-4046 upon completion. <br />` Hard Copy - Job Site Pink Copy - Contracfor White Copy - Mal <br />nivs vi <br />iau�iw <br />