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'4IP•w/sFA <br /> CITY OF EVERETT <br /> PIPING TEST AFFIDAVIT <br /> Owner 0 • 13 4- 2./.L= <br /> Job Address ec a2 ( ' le T t2 52- Permit No." 1/c 2 -c 3 <br /> The refrigerant/ natural / LP / medical gas system (circle one) was tested at 4='O psi for a <br /> total of - minutes. <br /> WITNESSED BY Date <br /> (Signature of occupant requesting gas service) <br /> INSTALLED BY `14/1 �e, ,f�v„L Date 2//,,7/6 <br /> (Signature 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 2I V <br /> PWPTA(5/17) <br />