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CITY OF EVERETT <br /> GAS PIPING TEST AFFIDAVIT <br /> Homeowner � �,T_ L <br /> {t Gzl <br /> Address_ f I 5T- S. W. ��Je�� Permit No. � �' yG 3 �-/1- <br /> -- <br /> The gas piping system was tested at psi for a total of minutes. <br /> WITNESSED BY_ azure mac/ <br /> signature of oc p requesting gas service) (date -- <br /> INSTALLED BY_ <br /> (signature of installing gas fitter) date <br /> Please arrange for someone to be present on the date of requested inspection to provide <br /> access forth(-,- inspector. <br /> Hard Copy - Job Site Pink Copy - Contractor White Copy - Inspector <br />