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WASHINGTON ENERGY SERVICES <br /> Customer Assurance / Gas Piping Test Affidavft <br /> , <br />� Homeowner(or representative)_f"�.�t C _,.., I�..E(/Ll0 <br /> Address_ �OZS� !���_ Pe►mit No. ���(�� 03� <br /> T � �ping system was tested at � psi for a total o� � � minutes. <br /> � We Inatslled: Fu � ury�r <br /> � MAy 11 � D � _ ur,h Hv_ <br /> ...�,TY............... eaw� _ an.� <br /> P�rmo Se V ERETT <br /> WITNESSED�Pea � <br /> aturo. er a aut zed repreeermhve�— � at� ' <br /> INSTALLED BY "f . 1L__.l�L�_ <br /> (installer: p eue print name) (wt�) <br /> This affidavit doea not take the plece of a gas piping inspectioin peAormed by an inapector hom your <br /> jurisdiction. This affidavit is for the use of Washington Energy Services only. <br /> wuo� a2� NRIITE COW.OFFICE YEILOW COPY•JO!SITE(iNE10lOII�YIN►) <br />