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CITY OF EVERETT <br />GAS PIPING TEST AFFIDAVIT <br />Homeowner �o� �, 5 <br />Address ?� A 5'�(s} �,1 _�u, �d�r��'� U/i� Permit No. � � <br />The gas piping system was tested at �� Dsi for a total of�_minutes. <br />WITNESSED E <br />INSTALLED B <br />� date�� <br />r���-1 <br />(date <br />Please arrange for someone to be present on the date of requeated inspection to provide <br />access for the inspector. <br />,}ist'd Copy - Job Site Pink Copy - Contractor White Copy - Inspectrr <br />