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� <br />�. <br />CITY OF EVEREYT <br />GAS PIPING TEST AFFIDAVIT <br />Homeowner �h� Cc"`� �� <br />Addresa_ % v i i i7o�1�, /"o�h !�: f� ��' �'y y� `�a �' —Permit No. iI1 %�� <br />f minutes. <br />The gas piping system waa teated at ��—psi for a total of�_ <br />WITNESSED BY <br />I�lSTALLED BY � <br />occupant requeatiny yas <br />�r <br />G� �r�re e�� <br />Please arrange for so eone to <br />access for the inspector. <br />/o �� <br />(date <br />/'/,�.-1,' ,�f ?.�O/ <br />stalling gas fittpr) (date) <br />�sent o�he date of r i ueated inapection to provide <br />Hard Copy - Job Site Pink Copy - Contractor White Copy - Inspector <br />