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gn. CITY OF EVERETT <br /> PIPING TEST AFFIDAVIT <br /> Owner IVlQrjo(le ►1cjY--at"• <br /> Job Address WO 6 / 5/ Permit No. tA iod 3 ~a/ 7 <br /> The refrigerant line / atural / LP / medical gas system (circle one) was tested at psi for a <br /> total of tanutes. 1 k O S <br /> WITNESSED BY , / Date 3 <br /> (Sign tur=y cupant requesting ga ervice) <br /> INSTALLED BY Ut Date 3" 7C) ' (62 <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 ( � <br /> PWPTA(5/17) <br />