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SNOHOMISH COUNTY PLANNING & DEVELOPMENT SERVICES <br />GAS PIPING TEST AFFIDAVIT <br />Homeowner <br />Address ��s/� ��I �� Ku f eb �LJJ Permit No.�LL.l�?—�2 <br />The gas piping system was tested at � psi for a total of �/ D minutes. <br />WITNESSED BY <br />INSTALLED BY <br />_ -f 1 R � <br />��<_ c_<�% <br />xcupoM reques�ne U� <br />(sfpnahxey�insfaNinp 9os Mter) <br />��J � <br />(daRe) <br />�/�!� <br />(tlate) <br />Please arrange for someone to be present on the date of requested inspection to provide access <br />for the inspectoc The white copy must be mailed to Snohomish County Planning fk Development <br />Services, M/S # 604, 3000 Rockefeller Avenue, Everett WA 98201-4046 upon completion. <br />Hard Copy - Job Site Pink Copy - Conhoctor Whife Copy - Mdl <br />n�asin imsio� <br />