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� <br />� <br />Homeowner <br />Address <br />! p CC��D�C � <br />CITY O� EVERET i D <br />j1 DEC 2 6 2012 <br />L_.� <br />GAS PIPING TEST AFFID VIcT�-,, �,�: ���i`�-,L-�i. <br />Pe��rnit �c��+�ie�� <br />The gas piping system was tested at�_psi fo� <br />� n i <br />� :..' <br />WITNESSED BY <br />INSTALLED <br />accupant requesting gas serv <br />nature o( instailing gas <br />Permit No.� ��� `00 <br />tal of_�_minutes. <br />J� <br />(date) <br />�% ��1 <br />(date) <br />Please arrange (or someone to be present on the date of requested inspection to provide <br />access for the inspector. <br />Hard Copy - Job Site Pink Copy - Contractor White Copy - Inspector <br />