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,._�_:.._._...,..��,-r,-.�..,�....,�....._..r.--.—_ — <br /> _.._.._. __--�..._._..:,...�.:� -r�+-- <br /> r WASHINGTON ENERGY SERVICES <br /> Customer Assurance / Gas Piping Test Affidavit <br /> � , <br /> Homeowner (or representative) <br /> �- � �� t_ <br /> Address ��2-� �� ��" �L �>r�t'�-f Permit No.�0yd6 —L�L-, <br /> The gas piping system was tested at �— psi for a total of � J` minutes. <br /> / Wh Range� <br /> isolation Valve Location f'���� �� �� `"k^�Jr h�Gr��We Installed: Fu �ryer_ <br /> FpD�? � Unit Htr _ <br /> Boiler _ Other <br /> .. .. ;� � .. i �9 / ;.�jC� <br /> 1NITNESSEC BY _. ;%�,;'G�-�ii '" ' � ,;�i / `�'.(/ i.� / c� � .. <br /> (signature9itiomeownero thon presen�twe) (date) <br /> /"`�/// _c j,_.._ �/ � ( / � <br /> INSTALLEDBY / C er: ep ' ame) (date) <br /> This affidavit doe�ot ta e th ace o as piping inspectioin performed by an inspector from your <br /> jurisdiction. This affidavit is for the�u of Washington Energy Services only. <br /> �y�p ��d�yg WHITE COPV-OFFICE YELLOW COPV•JOB SITE(TAPETO EOUIPMEN?') �,ry�,y�ASHIES07403 <br />