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CITY O� EVERETT <br /> GAS PIPING TEST AFFIDAWIT <br /> Homeowner �N ` � <br /> Address � '=A 5�.— Permit No.� G�/O ` a� <br /> The gas piping system was testecl at psi for a total of � � minutes. <br /> WITNESSED BY � to ��• o ( <br /> (s gnatur occupant r s ing g ervice) (date <br /> INSTALLED BY��^'�� �� ���`— <br /> (signature of �nstalling gas fitter) (date <br /> Please arrange for someone to be present on the date uf requested inspaction to pravide <br /> access for the inspector. <br /> Hard Copy - Job Site Pink Copy - Contractor White Copy - Inspector <br />