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�c;� � <br />Homeowner <br />Address <br />y?,� L�'_���`;� -� �; <br />CITY O� EVERE�"T <br />GAS PIPING TEST AFFiDAVIT <br />The gas piping system was tested at_ <br />WITNESSED BY ,'^.� <br />(signat��re o occupa <br />INSTALLED BY <br />.1 <br />C '� <br />`L/ <br />ing gas <br />=�PermitNo.� lU�-z 'CJIz <br />i tor a total of /'1 minutes. I <br />ng gas service <br />r) <br />�J ' J �� <br />(date) <br />l �- /_$_.l �1_a <br />(date) <br />Please arrange (or someone to 6e present on the date of requested inspection to provide <br />a�cess for the i�spector. <br />Hard Copy - Job Site Pink Copy - Contractor White Copy - Insoector <br />