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, ._ .------ ----- - __. . <br /> _ - - -_- _ _ _. _r ------ - <br /> ; <br /> p�(� P t��r�2s� � 3 �3 i�t�u�� <br /> CITY OF EVERETT <br /> GAS PIP�NG TEST AFFIDAVIT <br /> Homeowner Df�ul(� DF'I�IZS�a� <br /> Address ,2313 �I�cl�c�. /}�z Permft No./M Y 9//-Gz� <br /> The gas pipinp system was tested �t � osf for a total of�_mtnutea. <br /> WITNESSED BY _������ ^^- ��7� �� <br /> (sipnature of occupant requestinp �as s�rvice (date) <br /> INSTALLED BY r > > � <br /> (sipnaturo nstal in� p�s tter ( �te � <br /> Please arranpe for someone to be present on th�date of nqu�sted Inapsction to provide <br /> accesa for the inspector. <br /> , Hard Copy - Job Site Pink Copy - Contr�ctor White Copy - Inspector <br />