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4FETTCITY OF EVERETT <br /> PIPING TEST AFFIDAVIT <br /> Owner r i 4 < ✓ <br /> Job Address I = Permi o. lAt i8b6-661 <br /> The refrigerant line / natural / LP / medical gas system (circle one) was tested at 15, 131 psi for a <br /> total of 3 0 mute . <br /> WITNESSED BY 1 Date`. :" G F <br /> /1 <br /> ignature of occupant requesting gas service) '`� <br /> • <br /> INSTALLEDBY Date /4 -/ <br /> ignature of installing g s fi er) G/,t�LCM /4&ito <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 />