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� � � <br /> ay <br /> � � m <br /> C H <br /> 9HN <br /> r <br /> y � H <br /> K n <br /> H � <br /> � M � <br /> VJ H <br /> h <br /> � O <br /> HC <br /> OH <br /> H^� g <br /> ^,Y �C <br /> � H [�J <br /> z <br /> HH <br /> g �' <br /> � <br /> � d � <br /> �� � <br /> HOfyi� <br /> 5NOhOMISH COUNTY COMMUNITY DEVELOPMENT <br /> GAS PIPING TEST AFFIDAVIT <br /> Homeowner �r` <br /> ( '�, Address _ �S �/ 7��_1��� �/��v ,— permit No. "—,3 ,3� <br /> ��' The gas piping system wa,� tested at�pgi for a total of � � <br /> minutes. <br /> � � <br /> 1�' 1 j�\ �7 . <br /> WITNESSED B'Y ��� t' 'SC� <<. � /`-� _ �J, s- ,/ � <br /> (sig ature of oc u ant re uestin ` �� <br /> � P g gas service) date <br /> � ?/� <br /> � INSTALLED BY � ���, �� � % <br /> �_) (signature ot ins all g gas fitter) �a e � <br /> (�� Please arrange for someone to be prese�t on the date of requested inspection to provide <br /> access for the inspector. The white copy must be mailed to Snohomish County Community <br /> �' Development, 4th Floor, Administration Bldg., Everett, WA 98201 upon completion. <br /> � Hard Copy - Job Site Pink Copy - Contractor White Co <br /> t , PY - Mail <br /> co��o� <br /> ' <br />