Laserfiche WebLink
� <br />� <br />Homeowner <br />C;ITY O� EVERETT <br />GAS �IPING TEST AFFIDAViT <br />Add��ss ����V� . ! . �v�rl tf ��.� , - Permit No ��� �O Y -d(5 <br />Th�� gas pining system was tested at �•'�_psi for a total o� �`] minutes.,—J <br />4"JITNESSED �iY <br />WSTA�.LED BY <br />{signatur� of occupant requ <br />ture,bf iHstalnng <br />Picase arrange for someone to be present on <br />�ccess fur the inspector. <br />� �� i `� <br />ng gas service) (date) <br />� : - _ ��� <br />itter) (date) <br />date of requested inspection to provide <br />Hard Copy -.lob Site Pink Copy - Contractor White Copy - Inspec4or <br />