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SNOHOMISH COUNTY PLANNING & DEVELOPMENT SERVICES <br /> GAS PIPING TEST AFFIDAVIT <br /> (Only for use in Occupied Buildings) <br /> Homeowner ��� ��'�� I 1�- <br /> Address 1��.-��r�l�� r aU� i Permit No. <br /> The gas piping systerr�, as tested at � � psi for a total.�.--of minutes. <br /> � � �/�-/� <br /> WITNESSED BY --T (date) <br /> (signature ol occupaN requesung gas scrvice) <br /> INSTALLED BY ���,�-�L� 1 � ` � � / 2 <br /> (sic�naWre of i talling ga hner) (date) <br /> Please arrange for someone to be present on the date of requested inspection to provide access for the <br /> inspector. The white copy must be mailed to Snohomish County Planning & Development Services, <br /> , M/S #BQ�, 3000 Rockefeller Avenue, Everett WA 98201-4046 upon completion. <br /> White Copy- Mail Hard Copy-Job Site <br /> iroaim <br /> �m <br /> �� <br />