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� <br />� <br />CITY OF EVERETT <br />GAS PIPING TEST AF'FIDAVIT <br />Homeowner 1 �^ � �2'i i,,�� �n I <br />Address `�1�1�)9 l�l�l i / i,'r�.� I�. ;;,,,,,7/ hl� �!rrn,Permit No. �7/ i;, - <br />The gas piping system was tested at �r psi for a total of �"-~ minutes. <br />� <br />WITNESSED BY � �-,v� > :Z. r<J^-��"1��-�,� <br />(signature of occupant requesting gas <br />i � � _ <br />(date) <br />INSTALLED BY '�•'��/` � - - —J� <br />(signature of installing gas fitter) (date <br />Please arrange (or someone to be present on the date of requested inspection to provide <br />access tor the inspector. <br />Hard Copy - Job Site Pink Copy - Contractor White Copy - Inspector <br />