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CITY OF EVERETT <br />PIPING TEST AFFIDAVIT <br />Owner I"' t (P t' nW le, <br />Job Address `7(aOs— gj&—L) -pjon. Permit No. I i Ffo� - OV <br />The refrigerant line / natural / LP / medical gas system (circle one) was tested at 10 psi for a <br />total of minutes. <br />WITNESSED BY _ <br />(Signature of occupant <br />INSTALLED BY <br />Date _'0-7 16 /J� <br />Date O 7)`.6 % 1 J <br />Please arrange for someone to be present on the date of requested inspection to provide access for <br />the inspection. - <br />REFRIGERANT CONTAINING PARTS OF THE SYSTEM THAT IS FIELD ERECTED SHALL BE TESTED FOR LEAKS ATTEST PRESSURES NOT <br />LESS THAN THE LOWER OF THE DESIGN PRESSURES OR THE SETTING OF THE PRESSURE RELIEF DEVICES. THE DESIGN PRESSURE <br />FOR TESTING SHALL BE THOSE LISTED ON THE CONDENSING UNIT OR COMPRESSOR UNIT NAME PLATE. (WAC 51-42-1108) <br />Hard Copy - Job Site Pink Copy - Contractor White Copy - Inspector <br />PWPTA (5/17) <br />