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CITY OF EVERETT <br /> GAS PIPING TEST AFFIDAVIT <br /> Homeowner �� �-"L�"'�'�""�'l'� <br /> Address � l� � % = Permit Na � � . -S <br /> The gas pipinp system was tested at /�osi for a total of,�.LZ_minutes. <br /> WITNESSED BY � ' ��� <br /> (s yn urs ot occupant r estinp yas service) (date <br /> l � <br /> INSTALLED BY �date � <br /> ( ture of insta liny �as fitter) (� <br /> Please arranye for som oe ne to be present on the date of requested inapection to provide <br /> access for the inspector. <br /> Hard Copy - Job Site Pfnk Copy - Contractor White Copy - znspector <br /> � � �u�/-�e ��f'� ��n��� a/s/�� <br />