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�� <br />� <br />„:. <br />.CITY OF EVERETT <br />GAS PIPING TEST AFFIDAVIT <br />Homeowoer ?�%AS � (L2e,�,✓ <br />Addrcss �� � _ ��„i s r .c/ Permit No. n+ �// — _d� <br />The pas pipinp syst�m was tested at i5. f' psi tor a total of_�_minutes. <br />h` <br />WITNESSED B' <br />INSTALLED BY <br />� f� 00 <br />( �te <br />� .t. saDa <br />Please arranqe for someone to be present on the date of roqu�sted inspection to provide <br />access for the inspector. <br />Hard Copy - Job Site Pink Copy - Contrector White Copy - Inspector <br />�'� <br />