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�;,;------- - --_..,-_,�..._�__...._w - - - _ � - <br /> WASHING70N ENERGY SERVICES <br /> Customer Ass�rance / Gds Piping Test Affidavit <br /> Hom�owner (ar representative) �IS��(L����'_C� OLL-- <br /> Address `�"� �Jr o T�__N_��j,�- �',��_ Permit No. � U� 3 '�,3,� <br /> The gas piping system was tested at � psi for a toial of � minutes. I� <br /> Wh '�Range <br /> Isolation Valve Location ���9� ��• �� we Installed: Fu '�Dryer <br /> Fpl �Unit Htr _ <br /> Boiler Other <br /> � <br /> WITNESSED BY - �/ O 7 /,,�ODO <br /> (eignature o h eowner or euthorized representative) (date <br /> INSTALLED BY �� �FF �(7 U L�� �� <br /> , installer: please print name) ���� <br /> This affidavit does not take the place of a gas piping inspecticin performed hy an inspector from your <br /> jurisdiction. This affidavit is for the use of Washington Ene;gy Services only. <br /> weo2 Ytamy WHITE COPY-OFFICE YELLOW COPV-,IpB SITE(7APE TO EOINPMENT) � <br /> . . . . lk.Na W.�SHIES07�0.1 <br /> . . . . .. .��.,- . ... ..'. �� �• �...�:�1ic-�_4 ' .'.-� � ... � . � . . <br />