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GAS PIPING TEST AFFIDAVIT <br />Owner's Name �i� �21.� • � � - I E'_Ct�-��7 V �1-_ <br />- - ----- - - <br />v <br />JobAddress_�.`_�.V_3_-'�-?r� �1.,.�7�`---------------- PermitNo.��IJ�— <br />(206) 670•1256 � <br />Installing Coniractor _ RELIABLE SHEET METAL� INC./DBA ARCO INSTALLATION, LTD._ phone __1•800-869•7043 <br />The gas piping system at the above address has been under pressure test for �*� <br />l\ . <br />a�/�Q__ Minutes at _`CJ_. —_ pounds- without leaking. <br />////—' -f n <br />Signature of Installing Gas Fitter _��%1 _ j��_,����_ Date %a���/�ti__ � <br />� f / 7. J'.� � <br />Signature of Home er—�'�' _._. . � y� � .- -.- ---_-------..- - _ _. - _ . Date�`_-t � U _. . _. <br />, C �- <br />