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CITY OF EVERETT <br />GAS PIPING TEST AFFIDAVIT <br />Address �vG `� 3 y� s�` v Permit No.�t ,� i0 -'d �� <br />The pas pipinp system was tested at o� � osi for � total of `�s minutes. <br />WITNESSED BY� _ ♦ � _ �� %" �a <br />s pnat o occupant roq st np 9u ^^ �::e`—� �aate <br />INSTALLED BY <br />, <br />pas <br />� dats <br />Please arranqe for somsons to be prosont on th� date of nqu�sted inspectfon to provide <br />acceas for the inspector. <br />. Hard Copy - Job Site Pink Copy - Contnctor Whits Copy - Inspector <br />