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El <br />Homeowner '7vYt <br />CITY OF EVERETT <br />GAS PIPING TEST AFFIDAVIT <br />tv P —v <br />Address2S L/� j %9� / Permit No. D D -oo� <br />The gas piping system was tested at 1 ,j psi for a total of _minutes. <br />WITNESSED <br />INSTALLED BY <br />pant requesting gas sery <br />lure of in!�Mling gas <br />(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 />