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CITY OF EVERETT <br /> PIPING TEST AFFIDAVIT <br /> Owner Ise L. G I l a �,e of <br /> Job Address aceto \ I!\siS ,,,\,,°. et./-e.___ Permit No. M IaI O-O77 <br /> The refrigerant line / natural / LP/ medical gas system (circle one) was tested at /5 psi for a <br /> total of 15 minutes. ( <br /> WITNESSED BY "9/ (� Date / d —a?- <br /> (Signa ure o occiant requ ing gas •rvice) <br /> INSTALLED BY �� �� <br /> � Date JO —02 g, -/ <br /> -i. a ure .f'• p.. gas fitter) <br /> Please arrange for someone to be pres- 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 /> 1 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 i 0- <br /> ' <br /> PWPTA <br /> (5/17) <br />