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'� <br />� <br />CITY O�' EVERETT <br />GAS PlPING TEST AFFIDAVIT <br />Homeowner Ac�ce �n.�Pz�vS <br />Address IS3� Sww�T A�� Permit No, n�� 203 •o�� <br />The yas piping system was tested at is psi for a total ot '�� <br />WITNESSED BY <br />INSTALLED BY <br />(�signa{ure of occupant requesung gas service� <br />inutes. <br />�� �1 <br />(date <br />� 3 �z <br />(date <br />Please arrange for someone to be present on the date of re�quested inspection to provide <br />access for the inspector. <br />Hard Copy - Job Site Pink Copy - Contractor <br />� <br />, <br />White Copy - I�specto a' l <br />/d <br />