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� r � <br /> � <br /> v� s <br /> �HxN <br /> HXH <br /> �i C] <br /> H � <br /> �I N 'U <br /> tn Fi <br /> x <br /> � �H17 <br /> OH <br /> � � g <br /> �Y (� <br /> � y� SNOHOMISH COUNTY COMMUNITY DEVELOPMIENT <br /> g N H GAS PIPING TEST AFFIDAVIT <br /> c� C �+ <br /> � t�1 1 <br /> ti <br /> y rn Homeowner I . Y� � • 1 ' :r I i-� � --i C <" <br /> � � � <br /> Address = � � � � �'1 U�'cz (.t�' \ .' (' �1 i ,ai :� <br /> ` Permit No. �.u'�' � � . '�7 +, <br /> �' � <br /> The gas piping system was tested at � -` psi for a total of. � minutes. <br /> � <br /> �� � <br /> � WITNESSEDBY �����. � •� ii,.} i �. ti�- 'r � —�� � �_ <br /> (signature of occupant requesting gas service) (date) <br /> �l <br /> / i_. , <br /> �_ / � <br /> � INSTALLEDBY _L�G(. Y��/ � ��-� -!� � '"'� � <br /> �J �_/ ' <br /> ' �(signature ol installing gas firie� (date) <br /> �� Please arrange for someone to be present on the date of requested inspection to provide access for thc�inspec o�. <br /> The white copy must be mailed to Snohomish County Community Dovelopment,M/S q710,5lh Floor,A�iministration <br /> _1_' '�Idg.,Everett,WA 98201 upon completion. <br /> � , <br /> � ,,, HardCopy-JobSita PinkCopy-Contractor WhiteCopy-Mail <br /> co-�or <br /> i <br /> �'. <br />