Laserfiche WebLink
GITY O� EVERETT <br /> GAS PIPING TEST AFFIDAVIT <br /> Homeowner '`���iv_�(1�� <br /> Address_ 3`'I � �� .v02j—y,J ' � E�t��� Permit No. O `�t /� ��1� <br /> � <br /> The gas piping system was tested at �`T_psi for a total o( /�_minutes. <br /> WITNESSED BY I�"7�� � L� ' /� <br /> (signature of occupant reque ing gaa service) (date <br /> INSTALLED BY ��� <br /> (signature of installing gas fitter) (date <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 />