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CITY OF EVERETT <br /> GAS P�PING TEST AFFIDAVIT t , <br /> Homeowner, �.�n►t�►;.r1 � • '••' aova d� LiQI.S C_t..ilb <br /> . <br /> Address �,7 S LJ P.45atb RD ___ Permit ���� <br /> The gas pipinq syatem was tested �t �� osi for � totd of�_minutes. <br /> WITNESSED BY y ' �� <br /> (s ure a occ pan request np q�� ��rv c� �oate <br /> INSTALLED BY . ���— � <br /> ( qn re o installinp p�� t tter) ate <br /> Piease arrange for someone to be present on the date of nqu�sted inspectlon to provide <br /> access tor the inspector. <br /> Hard Copy - Job Sfte Pink Copy - Contractor White Copy - Inspector <br />