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� � _ . - --- <br /> CITY OF EVERETT <br /> GAS PIPING TEST AFFIDAVIT <br /> Homeowner �M Aev C�.IN N l NG N 4 w1 <br /> Address �(005 ��4r�;s �� Permit No.�991 � -D$8 <br /> The gas pipin� syste e e � si for a total of �o� "� minutes. <br /> WITNESSED 8Y �� 99 <br /> (sip turq o occupant request np �as s�rvice) ( ate <br /> INSTALLED BY .���� � ��`� � ,�.� °��I. <br /> (signaturo of nstal inp �as fitter) (date <br /> Please arrange for someone to be present on the date of roqueated inspectlon to provfde <br /> access for the inspector. <br /> � Hard Copy - Job Site Pink Copy - Contncto� White Copy - �nspector <br />