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_ - - __ _ -- _ _ - _ <br /> � �. ,� �,� �20� 9/a� <br /> CITY OF EVERETT <br /> GAS PIPING TEST AFFIDAVIT <br /> Homeovune��SIVC� ��V�- �� <br /> Address l� C � a�� � ���� e-E- Q--��I.�R l�� Permi�.� (�3l/-a2Z <br /> The gas piping system was tested at, / �_Ps� for a total of�_minutes. <br /> WITNESS�D BY ��� �� D� �� � <br /> (si ture of occu nt requesting gas aervice) (date <br /> INSTALLED BY l�� � <br /> (signatur of installing gas fitter) (date <br /> Please arrange (or someorse 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 />