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4�r CITY OF EVERETT iN� <br />PIPING TEST AFFIDAVIT <br />Owner SOILA01'- <br />Job Address 6003 1 L I ST' C.VN51r,30 L� Permit No. R1401 -0 5' <br />The refrigerant line / natural / LP / medical gas system (circle one) was tested at psi for a <br />total of minutes. <br />WITNESSED BY �� Date <br />nature of occupant requesting gas service <br />INSTALLED BY /No�AbAy ,� �,5 Date /1-17_ /q <br />fl o. �. <br />—(S gnatu di inbialling gaSiliMQ <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 LEAK 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 NAMEPLATE. (WAC 51-42-1108) <br />Hard Copy — Job Site Pink Copy — Contractor White Copy — Inspector <br />