HomeMy WebLinkAbout1012 4TH ST_1322_2026 CITY OF ARLINGTON BUILDING DEPARTMENT
GAS PIPING TEST AFFIDAVIT
Homeowner .
Address Z01` A S7' Srr Permit No. 1
,2 L�
The gas piping system was tested at_ -S�_! .psi for a total of minutes.
WITNESSED BY� _ --L��
l �
(signature of occupant reque tis� ng as service) (da e)
INSTALLED BY s fitte � (date)
(signature of installing g
Please arrange for someone to be present on the date of requested inspection
to provide access for the inspector. The white copy must be mailed upon
completion to: City of Arlington - Building Department
238 N. Olympic
Arlington, WA 98223
Hard Copy - Job Site Pink Copy - Contractor White Copy - Mail
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