Laserfiche WebLink
CITY OF EVERETT <br /> GAS PIPING TEST AFFIDAVIT <br /> Homeownv,r <br /> Address� (_��c� � '�J9 L ieI C� � l�/�� Permit No. �� 5 d�o�/ <br /> � � <br /> Tlie gas piping system was tested at I `Tpsi tor a total of.�_minutes. <br /> WITNESSED BY �--1'`� �91.� �`'1l�nlc� �oh� —1V�G• S ��J f �D <br /> (signature of occupant requesting gaa service) (date <br /> INSTALLED BY /1/7"dl� �nY�yf� � � l-�e.�_��v�c 5 J 1 7 � <br /> (signature of installing gas fitter) (date <br /> F�Icase arrange for someone to be present on the date of requested inspection to provide <br /> .,ccess for the inspector. <br /> Hard Copy - Job Site Pink Copy - Contractor White Copy - Inspector '-i�. <br /> :� <br />