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CITY OF EVERETT <br />AS FIRING TEST AFFIDAVIT <br />Homeowner <br />� �TC-VL L IAN JQYL <br />Address 192,rr1 /L NDT-L, S Permit No. <br />The gas piping system was tested at Zd psi for a total of �� minutes. <br />WITNESSED BY:-AL(date)— <br />(signature of occupant requesting gas service) <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 for the inspector. _ <br />G'RA%l S WtS <br />Hard Copy - Job Site Pink Copy - Contractor White Copy - Inspector <br />