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� <br /> ��_ <br /> . .: . <br /> : _ _ _ .._ .._ _ -«_____ , <br /> CITY O� EVERETT <br /> GAS PIPING TEST AFFIDAVIT <br /> Homeowner <br /> Address 5'�" <br /> Permit No. no�5_D�cS <br /> fhe gas piping system was tested at_ � '�J psi for a total of_ � _minutes. <br /> WITNESSED BY ��� <br /> (signa of occupan requesting gas service) (date <br /> INSTALLED BY /7 <br /> ( ign�ture o in talling gas (itter) �a��� <br /> Please arrange tor someone to be present on the date of requested inspection to provide <br /> access for the inspector. <br /> Hard Copy - Job Site Pink Copy - Coqtractor YJhite Copy - Inspector <br />