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CITY OF EVERETT <br />��Q��bl� <br />.�q N !�� <br />..... . 2 419g� <br />PIPING TEST AFFIDAVIF�rr oF` --- ...... <br />lei c�Csa�J Pub,;� wo k�ERErr..... <br />�� <br />Address � ZO W,f„[,w��. Permit No. "� 9 <br />The gss pipinq system was tested at IS � psi for a total of �.� minutes. <br />�� � <br />WITNESSED BY �� "7 L�� <br />(si t�o u nt requestinp pe: �.ervice) (date <br />INSTALLED BY ��c.�- 2 � <br />(sipn�turo o ins I iny pas <br />. <br />� �d�te � <br />Please arrange for someane to be present on the date of requested inspection to provide <br />access Tor the inspeator. <br />Hard Copy - Job Site Pink Copy - Contractor White Copy - Inspector <br />