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Homeowner <br />�ITY OF !'VERETT <br />GAS PIPING TESl' AFFIDAVIT <br />�c�.ao1 �, �s2JHc� <br />The gas pipiny system was tested <br />WITNESSED �Y <br />INSTALLED BY <br />�.,-- �� —dZ�l <br />_Permit No. �l <br />totd of / minutes. <br />I <br />( ate �`� <br />�/� o0 <br />.�e <br />Ptease arrange for someone to be present on the d�te of requested inspectfon to provide <br />access for ihe inspeCtor. <br />Hard Copy - Job Site Pink Copy - Contractor White Copy - Inapector <br />