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CITY OF EVERETT <br />OL SAS PIPING TEST AFFIDAVIT <br />Homeowner T <br />Address-4-6-� Permit. <br />The gas piping system was tested at_L Psi for a total off_minutes. <br />WITNESSED BY L.f L j <br />t <br />(signature of occupanrequesting gas service) (date) <br />INSTALLED BY <br />(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 />