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CITY OF EVERETT �'3 042000 <br /> GAS PIPING TEST AFFIDAVIT C,Perot ervERs7T <br /> Homeowner <br /> Address S� S.w Permit No.Lale 2-2- <br /> The <br /> 2The gas piping system was tested at--LS—psi for a total of 5 minutes. <br /> WITNESSED BY, .�d - (/ ,111�jl, — ` L <br /> (signature off occupy questing gas service) (date <br /> INSTALLED BY �W7 "�I" � U,7 <br /> (signature of installing gas fitter) (date <br /> Please arrange for someone to be present on the dale of requested inspection to provide <br /> Nccess for :he inspector. <br /> Hard Copy - Job Site Pink Copy - Contractor White Copy - Inspector <br />