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SNOHOIVIISH COUNTY PLANNING & DEVELOPIVI�NT S�RVICES <br /> GAS PIPING 7ES7 AFFIDAVI7 <br /> (Oniy for use in Occupied Buildings) <br /> Homeuwner __���1 f�' / ''r J��%"' ��C�, 4q�r ir� r t / _ <br /> Address Z. 7r� CC�7`n�c� -� �5"�� PermitNo. �vIl�C� j D/� <br /> Thc gas piping �ystem was tesled at � 7 psi tor a total 3 � of minutes. <br /> h � <br /> WITNESSED BY � ���� �_/ 7// /�l <br /> . (si�nm�ro ot � ps I ruqueaang pas samttJ ioa�cl <br /> INSTALLL-Ut�Y.._. � �' �� �� ° �! '� � �� .--."Ll��l � . <br /> �/ .(nlqatWl0bI4�51awn99a61�tlep l0ate� <br /> Please arrango tor someone to be present on the date of requested inspection to provide accnss tor the <br /> inspector. Tha wfiite copy must he mailed to Snohomish County Planning 8 Development Services, <br /> M!S x60a, 3UUD Rockefelier Avenue, Everott WA 98201-A046 upon cornpletion. <br /> � Whlte Copy—Mdil Nun1 Cupy—JuD Silo <br /> �� <br /> uu�o� <br />