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1 <br /> CITY OF EVERETT <br /> GAS PIPING TEST AFFIDAVIT <br /> � <br /> Homeowner �V`•`e� �"��� -�� �• <br /> Address �'� % �'�c ! � � _ Permit No. <br /> The gas piping syatem was tested at -�� psi for a total o( �--� minutes. <br /> WITNESSED BY � ' �--�� �� <br /> (signature ot occupant request�ng gas service) (date <br /> , � ,— <br /> INSTALLED PY '��1���^� j �0�� ��� � ') ' � <br /> (signature o in Iling gas ilter) (date <br /> Please arrange for someone to be present on the date of requested inspection to ��rovide <br /> access for the inspector. <br /> � Hard Copy - Job Site Pink Copy - Contractor White Copy - Inspector <br /> � <br />