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_ _ , ._. _.,_ _ . _. <br /> of�� 5�` �� G � G' � <br /> _ � _ -- <br /> CITY OF EVEFiETT <br /> GAS PIPING TEST AFFIDAVIT <br /> Homeowner YD.��Q � �OJ�� <br /> Address �� l- I�Y��(� ' �� :�l ft� 2 al PQ�-i1 i�h�ga�� Permit No. �1�D 3//- o ZZ <br /> — G <br /> The gas piping syatem was tested at�_Ps� for a total of��minutes. <br /> WITNESSED BY l' 4' �`-'�� U�� <br /> ( i nature of occupant requesting gas service) (date <br /> INSTALLED BY I�\� � O� <br /> (signature of installing gas fdter) ( ate <br /> Please arrange for someons to be present on the date of requested inspection to provide <br /> access for the inspector. <br /> Hard Copy - Job Sits Pink Copy - Contractor White Copy - Inspector <br />