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10/21/2001 THU 09:00 FA%_ 125 268_6080 .T^._MAJON_INT_F_RIORS_ _ �OOI _ <br /> _— , � ... �. . � <br /> y ( i . �.�, . . . <br /> � .t. +( . -., . . .. � � . . � � .. . - <br /> CITY OF EVERETT <br /> GAS PIPING TEST AFFIDAVIT <br /> Homeowner �.,Clf�ill �vSCY� � Z� <br /> ,/So � i�t� K A� f�e, .Z.a -� <br /> Address � T Permit j. � <br /> The gas piping system was tested at�Pg� �or e total ot�minutes. <br /> i <br /> � WITNESSED BY / � <br /> � , (si a re t��pccupant r questing gaa service) �date <br /> � -- _ � <br /> INSTALLED BY ��' —'�date <br /> (signature of �nstalling gas titter) ( <br /> Please arrange tor someone to be present on the date o} requeated inspection to provide <br /> access for the inspector. <br /> Job Site__ . Pink Cop r�- Contractor White Copy - Inspector <br /> Hard Copy - - - - � <br /> _ � . ,.. .._,.. ., , , <br /> o � � /C���e,v j=,�x ��r�.��3�,z-.�5�s <br /> ., o <br /> � ° uu0000 s . D ;.� <br /> ..� : <br /> � � � _ � 3 /�� T��%A�F�o�V�r o ._, <br /> jN � r � m .. ..:. � � . <br /> < _ � ` /�-�/.D LG-r�2 �S'�n�clU _ � <br /> � - <br /> � �-!r3'T ,f//'•l,'7�iRs Fi2c'��c� <br /> � 1 %�C�E/Cf�/.�/llC� G✓/�"� � F � a Z <br /> u u �u u o o � � J/VSi7�-Lf-� %v ��'G `� � y •� <br /> ° � o � s ° " z � <br /> _ � o m <br /> � � � n � � � � �� �P�G'i�iCi�-��c�c.� ___ D ' � <br /> � � _ � Z _ _ . '-° : \ � <br /> � s <br /> m . e � r, .'i. <br /> � _ ° � ��/�Si1z)NS� /�4�5'E n � ...', '; � � . <br /> v �. Z <br /> o � �fl"L[.- /�IE �T�S`L�29'/��670 � V '`.� ^ � <br /> m c� <br /> u00000 .\ <br /> ,..\ N T N L� o m . . �. / D � � <br /> �..' c � � � � � ` ��_�.�,�,N O" <br /> � r �i > fl r n <br /> I ' Q � o � �, �yt /��.r-ctl-cl� 1' <br /> � i y/u in. <br /> v �t /s o�' .a�ucKc,��ti� <br /> '� _ _ . _ _ l���tf� L.t.l�. <br />