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� <br />�. <br />Homeowner_ <br />Address S � <br />L0'T � - <br />- <br />CITY OF EVERETT <br />GAS PIPING TEST AFFIDAVIT <br /><<..� i�, � F <br />The gas piping system was tested <br />WITNESSED BY <br />INSTALLED BY <br />�� �� <br />/��;��,-�"l <br />gas <br />�L.r�rF% Permit No. �'��Z-�Z <br />for a total of � C minutes. <br />gas <br />�� � <br />(date <br />���/� <br />(date} <br />Please arrange fdr someone to be present on the date of requested inspection to nrovide <br />access for the inspector. <br />Hard Copy - Job Site Pink Copy - Contractor White Copy - Inspector <br />