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r Migh"40 15� <br />aw.-ow-Al <br />Homeowner 1.d)r id <br />CITY OF EVERETT <br />GAS PIPING TEST AFFIDAVIT <br />M <br />Address-26 S � _ _ Permit No.'2'1,jC;0 V- cl fo <br />� r <br />The gas piping system was tested at f psi for a total of _minutes. <br />WITNESSED B <br />INSTALLED B) <br />1,?L2 Pl� <br />(date) <br />(date) <br />Picase arrange for someone to be present on the date of requested inspection to provide <br />;,ccess for the inspector. <br />Hard Copy - Job Site Pink Copy - Contractor White Copy - Inspector <br />