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� SNOHOMISH COUNTY COMMUNITY UE'.__ ENT <br /> GAS PIPING TEST AFFIDAVIT <br /> Homeowner ��Wl�/<� �/�Olec� . <br /> - Addresa � �.���� �ll�r-.�Dil �K. LvFLcr�'PertnitNo. <br /> v <br /> The gaa pipfng system was tested at �S psi for a total of � S minutes. � <br /> WITNESSED BY �i/1/� .0/ //��� ����3 <br /> (sig m of occupant requestinp gas service) (date) <br /> � IN3TALLEDBY �f7t� �� � �j_/�� <br /> �(sipneture ol imtallirp pas fMe� (date) <br /> Please arrange for nomeone to be present on the data ot requested inspeetfon to provide aceesf fa the Inapactor. <br /> i The white copy must be mailed to Snohomish County Communiry Devebpment,M/S 11710,Sth Floor,Administration <br /> �Bldg.,Everett,WA 98201 upon completion. <br /> HarACopy-JobSite PinkCopy-Contrectw WhitaCopy-Mail <br /> C0.101 <br />