When ready for an inspection, call 435) 865-4519 for an appointment.
Have your Gas Clearance form at the test gauge for the inspection.

Date*

Contact Name*

Contact Phone*

Project Address*

Project City*

Project Subd.*

Unit(s) #*

Owner/Building*

Permit #*

Fuel Line Size*

a 2-lb. meter set ONLY with 701 C.F.H. and greater)

CFH*

Pressure Set*

To be filled out by inspector:

Building Inspector Signature

Date Sent to Gas Company

Date Inspected