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CITY OF EVERETT <br />4wr GAS PIPING TEST AFFIDAVIT <br />Homeowner % n/� do&B <br />Address a?/,OQ A_!jn&&xz4 Permit No. S7S/3'C, <br />The gas piping system was tested at /(a. psi for a total of YZminutes. <br />WITNESSED BY <br />INSTALLED B <br />J� '� <br />(date) <br />Y <br />l/c t _02_j.9 <br />signature of installing gas fitter) (date) <br />Please arrange for 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 />