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WASHINGTON ENERGY SERVICES <br />Customer As�urance / Gas Piping Test Affidavit <br />Homeowner (or representative) <br />Address L��D��ULlvL S'T. E� <br />ThQ gas piping system was tested at <br />Isolation Valve Location <br />WITNESSED BY <br />� <br />��_ Permit No. �w <br />psi for a total of I� minutes. <br />Wh _ Range <br />We Installed: Fu _ Dryer <br />Fpl _ Unft Htr _ <br />Bofler _ Other <br />8 �ZZ-� Z <br />( te <br />;NSTALLED BY �� 4-y� �' 1O ' - � �Z� �Z <br />( ta!ler ease print name) ( ate) <br />This affidavit does not take the place of a gas piping inspectic,in performed by an inspector from your <br />jurisdiction. This affidavit is for the use of Washington Energy Services only. <br />w802 YN9� <br />WMITECOPV•OFFI:.F VELLOWCOPY-JOBSITE(TArETOEWMMEMT) ��,yyASHIES0710.7� <br />