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CITY OF EVERETT <br />PIPING TEST AFFIDAVIT <br />Owner i v e <br />Job Address/30�" ✓ Permit a 1 <br />The refrigerant line / natural / LP / medical Glas systemercl one wa tested at psi- or a <br />1-01NI�n 7% <br />total of minutes. 6,tl F4-oL-3 4.1,4- Are-q D <br />WITNESSED BY Date <br />(Signature of occupant requesting gas service) ` <br />INSTALLED BY <br />c1445 Date <br />� <br />( nature of inst 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 />PWPTA (5/17) <br />