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Homeowner V V1 <br />CITY OF EVERETT <br />PIPING TEST AFFIDAVIT <br />v ^ I i,- <br />Address 7`1 ZS [—�T yr V _ i Permit No:%%%<i-t12' <br />The gas piping system was tested at _psi fora total of6, minutes. <br />NJ <br />WITNESSED BY <br />(signat� t occupant requesti <br />INSTALLED BY <br />signature of installing gas <br />G� <br />gas service) (date <br />t l-6ejl-� <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 />