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#11P/44://--1 <br /> CITY OF EVERETT <br /> PIPING TEST AFFIDAVIT <br /> Owner II�� <br /> Job Address 83 0 (ea l ) 4`7 IJ i( Permit No. P 16 C q ` d , <br /> INCenn,►J 1.04-" 'GR PA ass Laza <br /> The - •_ ' - - _ _ -- - _ _ __ - _ - ' - - was tested at (P0 psi for a <br /> total of c?0 minutes. LOT-It "5 � h -.e& <br /> WITNESSED BY Date <br /> (Signature of occupant requesting gas service) N1.IXeSPtr9.4.04- n <br /> INSTALLED BY MIKE-NI' -uJei s ""63$ P1„4)w"60-14"N11¢s*►tiate S 4.2-01% <br /> d (r S re oks��) <br /> nstz..ltQ r" <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 />