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Mar O1 11 10: 09a DRVEMPORT DEVELOPMEnT IHC 4252590824 p. 3 <br /> CITY OF EVERETT <br /> GAS PIPING TEST AFFIDAVIT <br /> Homeowner � � � � � �. • � '. � //��l rl� �y. <br /> Address ',,- 'i. �Y �_� :;.�:it�i%� /: �;:�.-: ,� h' -i PermitNo.7Ji<�'IC•� . <br /> / ' J \ __! <br /> � �; <br /> The gas piping system was tested at / '� psi for a total ot __ minutes. <br /> WITNESSED BY � �. � -';' <br /> (�signature of occupanl requesting gas�service) �date <br /> / <br /> ` � , �.�._^-.__ i <br /> INSTALLED BY 7�' C ' ` � c , <br /> % (signature of installing gas fitter) �date <br /> � - <br /> Please arrange for someone to be present on the date of requested inspection to provide <br /> access for the inspector. <br /> Hard Copy - Job Site Pink Copy - Contractor White Copy - Inspector <br />