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El <br />Homeowner <br />Address__ <br />CITY OF EVERETT <br />GAS PIPING TEST AFFIDAVIT <br />The gas piping system was tested <br />WITNESSED Bl <br />INSTALLED BY <br />r�!n(p _a2il <br />Permit No. <br />for a total of minutes. <br />(date) <br />(date) <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 />