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Orre". CITY OF EVERETT -� � <br /> PIPING TEST AFFIDAVIT �t B <br /> (tan"-Lti'dt <br /> Owner skqm 095 <br /> Job Address '53O (J./try-ten 1%,14, £tA- Permit No. ./14/50-#04/ <br /> he re rlgerant l!r_9 natural / LP/ medical gas system (circle one) was tested at VSe,l psi for a <br /> total of 3 --m., s. d y <br /> WITNESSED BY (/ Date <br /> (Signatu o occupant re uesting gas service) <br /> INSTALLED BY Date 5 <br /> ig ture of install' g gas fuer) <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 />