Laserfiche WebLink
� <br />� <br />0 <br />CITY O� EVERETT <br />AS PIP,ING TEST AFFID�KVIT <br />Homeowner / ' /'CNNc�{i � tL�ovNasJ _Gc.S I�U'"l.�' <br />Address���,� = i� � - � % n C Permit No. ��% �c4 <br />The gas piping syste .i�sted at �� psi for a total of�_minutes. <br />WITNESSED BY <br />INSTALLED BY <br />n <br />. <br />✓C` ✓I -�'�� <br />o} occupan requesting gas se <br />.� c <br />(date � <br />i��/ <br />(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 />