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� <br />� <br />Homeowner <br />CITY OF EVERETT <br />GAS PIPING TEST AFFIDAVIT <br />. n ..— � , � <br />Address_( `1 / (� ___�_I=CGT/�T Permit No. %�� p�� <br />�J <br />The gas piping system was tested at a� psi for a total of `� aa+�te5:' 1��� <br />WITNESSED BY <br />(signature of occupant requesting gas service) (date <br />INSTALLED BY��f'►'D�I�a�cCC)� ! �a�/ �V <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 />