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CITY OF EVERETT <br /> PIPING TEST AFFIDAVIT <br /> Owner Z <br /> Job Address /(0 O / # SPermit No. (_ f9' 1 0 c),2 <br /> The refrigerant line/ natural LP / medical gas system (circle one) was tested at psi for a <br /> total of /5-- <br /> minutes. <br /> WITNESSED BY Date <br /> (Signature of occu.- requesting gas service) <br /> INSTALLED BY \ <br /> Date l2/s I It <br /> (Signature of install g itt9v) ---- <br /> Please arrange for someone <br /> 4 ----, 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 ;'\C' <br /> PWPTA(5/17) <br />