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CITY OF EVERETT ' <br /> GAS PIPING TEST AFFlDAVIT <br /> Homeowner ��'��'� C�"�� �� f ��?`'�' <br /> Address J�N�S � �% u2 w �vc�c.�` PermitNo. �f0 —�/Ct <br /> The gas piping system was tested at�psi for a total of�riinutes. <br /> ,'1 <br /> WITNESSED BY ��QC�LI�C l� Ci �� 4JC�l L � / � <br /> (s— i—lgr�u e of occupant requesting gas service) (date <br /> INSTALLED BY HU- S �>>S�.0 /fib �Tr�NS�u. G� ; F� /�%� Gy <br /> (signature of installing gas fitter) ���H�y-S�u (date <br /> Please arrange for someone to be present on the date of requested i�nspection to provide <br /> access for the inspector. <br /> Hard Copy - Job Site Pink Copy - Contractor White Copy - Inspector <br />