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��� <br />H <br />C H <br />9Hy <br />r <br />H � <br />fC C] <br />oH �1 <br />�tlH� <br />CA H <br />H <br />�O <br />H tl <br />OH <br />H�g <br />�V n <br />t"y� <br />ti y <br />g�' <br />H <br />C�Cq[n <br />�y� <br />HOtn <br />�_..�.�__.. . _ . .. ............ _ _ . _ . _._.. .__._.�....--- <br />��.. <br />f <br />SNOHOMISH C�UNTY COMMUNITY DE�iELOPMENT <br />GAS PIPING TEST AFFIDAVIT <br />,. <br />Homeowner %y 7 t' �-/" ^ f i <br />�'�� Address < �! � % �• � ` �"' f- �"%" • Permit No. <br />��� The gas piping system was tested at,_ r_ psi for a total of /r �,minutes. <br />WITNESSED BY :, :. „ ^ —fdate <br />(signature of occupant requesting gas service) ( <br />� � ���:. <br />IkSTALLED BY : ;. �; '' ., � . . . � S ,�f '�� � / ; ;',;: <br />• .�fs�anatu�e of instslling gas fitter) -a.. (date <br />�.-•.. � <br />µ�- <br />Please arrange for someone to be present on the date of reqt <br />access for the�inspector. The white capy must be mailed to : <br />Development,':4th Floor, Administration Bldg., Everett, WA 98 <br />a Hard Copy - Job Site Pink Copy - Contractor <br />�` <br />` �,�:. <br />' .ty�C13•lav . � ' � <br />' .�:yJc 'i.�,r'::s . . . � � ... <br />- «--^-'- � <br />1�1 inspection to provide <br />I�omish County Community <br />I�upon completion. <br />White Copy - Maii <br />