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m <br />/� / ; , \ <br />� \ <br />\ <br />CITY OF EVERE�T , <br />GAS PIPING TEST AFFIDAVIT <br />; <br />Homeowner �- � `` "'-�'`� ' � `"� <br />Address �U� �O �� � � �' �� Permit No./,'! � I //L' � �'�-3 <br />, � __ <br />The gas piping system was tested at � Z' psi for a total of !�� minutes. <br />� � <br />,�. <br />;. <br />WITNESSED BY <br />. , <br />, <br />! ,'; � . I</ <br />'(signature of occupant requ�sting gas aervice� �( ate � <br />` ' l <br />' -,- l�� l l,. -..,,� i ��; �; <br />INSTALLED BY �.t.,c-t_ , � I,I'1' i � ���`cG {_�� �' <br />(signature of instalimg gas fdter) (date <br />Please arrange for someone to be present on the date of requested inspection to provide <br />access for the inspector. <br />� Hard Copy - Job Site Pink Copy - Contractor White Copy - Inspector <br />