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� _._ �____�-�-.-- <br /> SNOHOMISH COUNTY COMlNUNITY DEVELOPMENT <br /> � GAS PIPING TEST AFFIDAVIT <br /> Homeowner � r�r �`<'h <br /> Address �, (�?�� I/i(�u.V�^5��`�i'�� PermitNo.�- ,;�' <br /> ~ The gas piping system was tested at /� Rgi for a total otJ`i �,?5 minutes. <br /> �, , � , <br /> WITNESSED BY ' /.., (,.�: �,i , �,i ,-�--'-, . _- _J ' �� <br /> (signature of occupant requestmg gas service) (date <br /> INSTALLED BY �� L-a ����" �J IJ' �r.� <br /> (signature of mstalling gas fitter) (date , <br /> Please arrange for someone to 6e present on the date oi requested inspection to provide <br /> access for the inspector. The white copy must be mailed to Snohomish County Community <br /> Devefopment, 4th Floor, Administration Bldg., Everett, WA 98201 upon completion. <br /> Hard Copy - .lob Site Pink Copy - Contractor White Copy - Mail <br /> �`� co-iov <br /> �� <br />