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OE77 CITY OF EVERETT <br /> GAS PIPING TEST AFFIDAVIT <br /> Homeowner E FF G /—' GVt <br /> C'7P14C>3 <br /> Address ✓fRf -7 w,4 __Permit No.�I � -crrpj <br /> The gas piping system was tested at psi for a total of_� minutes. <br /> WITNESSED BY <br /> (si0AaFU0&T occupant requesting gas service) (date) <br /> INSTALLED BY <br /> (STgnature of installi2g gas filter) date) <br /> Please arrange for someone to be present on the date of requested inspection to provide <br /> access for the inspector. <br /> Hard Copy - Job Site Pink Copy - Contractor White Copy - Inspector <br />