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� <br /> CITY O� EVERETT . <br /> GAS PIPING TEST AFFIDAVIT <br /> Homeowner � �� �� ��,� <br /> Address 311� 1 i�[,LFt�, Permit No. ��'038 <br /> The gas piping system was tested at � Ps1 for a total of�minutes. <br /> WITNESSED BY -- � z� � <br /> (si nature of occupant requesting gas service) (date <br /> INSTALLEDBY _-� �` �^'`� �—f ��� <br /> / ignature of instai ng gas fitter) (date <br /> Please arrange for s meone to be present on the date of requested inspection to provide <br /> access (or the inspector. <br /> Hard Copy - Job Site Pink Copy - Contractor White Copy - Inspector <br />