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CITY OF EVERETT �� <br />GAS PIPING TEST AFFIDAVIT <br />Homeowner ��a✓/f�i� i`9��r <br />Address /o ia �z.�A �'f' Permit No._ C�,,T� <br />The gas piping system was tested at /.5� osi for a total of�_minutes. <br />WITNESSED BY <br />INSTALLEO BY <br />��� <br />(date <br />,o �� <br />(date <br />Please arrange for someone to be present on the date ot requested inapection to provide <br />access for the inspector. <br />Hard Copy - Job Site Pink Copy - Contractor White Cop�r - Inepec[or <br />,,. : <br />