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CITY OF EVERETT <br /> � . GAS PIPING TEST AFFIDAVIT <br /> � _,, ;� , � , �� '� <br /> Homeowner oy��_oi7 <br /> J Permit No. <br /> Address_ <br /> The gas piping system was tested at�—P <br /> sf for a total of��minutes. <br /> /-,� �� J .��� <br /> WITNESSED BY date <br /> signatur o cc ant requ sting ges aervice) ( <br /> � � � � " (j r <br /> INSTALLED BY ` � � �� �' ' ' �'��`'�i�� ~1 �date � <br /> (signature of instauing gas t�tter) � <br /> Please arrange tor someone to be present on the dete of requested fnspection to provide <br /> access for the inspector. <br /> `� Pink Co Contractor White Copy - Inspector <br /> �— I-�rd Cop�r - Job Site py " <br /> 1 ' <br /> � "'. - - --- - <br />