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.r r•. nvcrrr.vr. j,.. <br />CITY OF EVERETT <br />rrGAS PIPING TEST AFFIDAVIT <br />� Homeowner_) I C l(< <br />Address 1// `/ ore % Permit No. <br />The gas piping system was tested at /r psi for a total of_C524 minutes. <br />WITNESSED BY <br />INSTALLED B <br />zj <br />s gnature o occup requesting gas service) (date <br />�j] I <br />Y� j j fI I <br />signature orinstilling gasfilter) (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 - tuspeator <br />