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_. <br /> i ✓ <br /> CITY OF EVERETT <br /> GAS PlPING TEST AFFIDAVIT <br /> Homeowner <br /> h Permit No.,�.� �l,� <br /> Address ZZ(� ���� S� � O O 'a <br /> i <br /> The gas piping system was tested at 1 S�Psi for a tote! 04 /� minutes. <br /> WITNESSECI B <br /> � ��� <br /> % ( iy ture of oc upant requestinp pas service) (date <br /> INSTALLED BY � ,/,`'�`n/ ` ���—�- <br /> (signature �f installing �as fftter) (date <br /> Please arrange tor someone to be present on the date of requeated In�pection to provide <br /> acr,ess for the inspector. <br /> Hard Copy - Job Site Pink Copy - Contractor White Copy - Inspec4or <br />