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CITY � �Q�� df� <br />OF EVERETT vcr , <br />3 19g� � <br />Homeowner _ C'AS PIPING TEST AFFIDAVI4��/cOF E� fR f""1 <br />- - ^ � — WOfks De� � <br />' Permit No,���z <br />The gas piping system was teated at�% s,-� S esi for a total of�� <br />minutes. <br />WITNESSED B' <br />INSTALLED BY <br />Please arrange for someone to be present on the date of requeated <br />access for the inspector. <br />l'�d//�b �,c ,4,.U. --�.t/�pc-3 ro.�J <br />Hard Copy - Job Site l���/�jnk C�� f�� �� /�/4� <br />� ate � <br />�(d te � <br />inspection to provido` / <br />�.rG /o �,3� � �.�aS%�,rj, <br />opy - Co t Ctor White Copy - Inspector <br />