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Ara CITY OF EVERETT <br /> PIPING TEST AFFIDAVIT <br /> Owner iG�'1�tl <br /> ie, Csorite/ <br /> Job Address 2.1 Y 4- Ced a' &31P 91201 Permit No. A 19021-025 <br /> The refrigerant line I natural / LP I medical gas system (circle one) was tested at \ psi for a <br /> total of 0 minutes. , <br /> Date <br /> G . , <br /> WITNESSED BY ° � µ <br /> (Signatureof_occupant requ,Csting 5a rvice) <br /> f <br /> INSTALLED BY __'' -i,- _.._- Date k <br /> (Signature of installing gas fitter) <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 AT TEST 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 />