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CITY OF EVERETT <br /> /A77--1,441 ,wi GREASE DUCT TEST AFFIDAVIT <br /> Owner <'` + D �. . <br /> Job Address / / le 3 2. E ted< i2 -c-r,1! iz-f-tdj Permit No./ 17 / 1 0 41/7 <br /> A light test or approved equivalent test Rethod was performed to determine that allawelded <br /> and brazed joints of the entire grease duct system are liquid tight. (IMC 506.3.31) <br /> WITNESSED BY 04:-.-Q001 33I-0A C',( 14.. $.., Date 11-2-S-- /7 <br /> INSTALLED BY ,-a o iti C40 ',), i2 �./� -5-i7,;1 Date II- 2(5-- /7 <br /> Please arrange for someone to be present on the date of the requested inspection to provide <br /> access for the inspection. <br /> Hard/Manila Copy-Job Site Yellow Copy-Contractor White Copy- ins eCto <br /> 0t <br />