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Fuel Gas Installation Form 03/19/2026 Address: Lot/Unit Subdivision: PERMIT **The test pressure shall be not less than 1 ½ times the proposed maximum working pressure, but not less than 3psig. Gauges shall have a range that is not greater than 5 times the test pressure. NATURAL GAS [ ] LPG [ ] SYSTEM OPERATING PRESSURE: 2 LBS. 4 OZ. OTHER: FUEL INLET LINE SIZE: List the number of units for each equipment/appliance(s): Furnace(s) BTU’s Specify Any Other Equipment: Water Heater(s) BTU’s Dryer(s) BTU’s Barbecue(s) BTU’s Range/Cook Top(s) BTU’s Boiler(s) BTU’s Fireplace(s) BTU’s TOTAL: BTU’s CONTRACTOR INFORMATION (Check which one applies) Builder’s Name: Contractor ( ) Owner Builder ( ) Business Phone: ( ) Mechanical Contractor: Business Phone: ( ) License I hereby certify that the entire mechanical fuel-line system for the structure located at the address listed above has been sized and pressure tested in accordance with the applicable codes currently adopted by the State of Utah. Printed Name of Installer Signature of Installer Date