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grrCITY OF EVERETT <br /> PIPING TEST AFFIDAVIT <br /> Owner 2 <br /> Job Address 3 001 ook - AVS :Permit No. 1 1/� <br /> 180 S--0) <br /> The refrigerant line I natural / LP/ medical gas system (circle one) was tested at L/00 psi for a <br /> total of /4/110 11O minutes. <br /> WITNESSED BY Date /b w <br /> (Signature of occu nt requesting gas service) <br /> INSTALLED BY Date 6) -(6 - / 8 <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 /> 977 <br /> PWPTA(5/17) <br />