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CITY O� EVERETT <br /> GAS PIPING TEST AFFIDAVIT <br /> Homeowner G'�-�-�' �"� IILE� <br /> Address ��U�D ��--A�—�P ""V�_ �T � 8�1 Permit No.MG1�o4—�� <br /> The gas piping system was tested at /,� psi for a total of H N�5 minutes. � <br /> � <br /> WI'I"NESSED BY <br /> /� �--� ��-�- � � sL <br /> (signatu�e ot occupant requesting gas service) (date <br /> INSTALLED BY 9/ ��/bf��� SJ� �v <br /> (s�nature qf in tal gas rtter) (date <br /> Please arrange for someone to be present on the date of requested inspection to provide <br /> access (or the inspector. <br /> , , Hard Copy - Job Site P�nk Copy - Contractor White Copy - Inspector <br />