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gn" CITY OF EVERETT <br /> PIPING TEST AFFIDAVIT <br /> Owner <br /> Job Address 1 l 7 23 AS D12, Sz& Permit No. &a. I/?e,CJ <br /> The refrigerant line / natural / LP / medical gas system (circle one) was tested at /1 psi for a <br /> total of 21) minutes. <br /> WITNESSED BY ; ' Date 0 -ler <br /> (Signatur of oc requesting gas service) <br /> , � <br /> INSTALLED BY /ObZ T5 P4/ Date -1/f <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 (.6 <br /> PWPTA(5/17) <br />