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477CITY OF EVERETT <br /> PIPING TEST AFFIDAVIT <br /> Owner Z.Z ,M-6/6/ <br /> Job Address i5Jd 1,44, Permit No. 1 Is07-cg2 <br /> The refrigerant line / natural / LP / medical gas system (circle one) was tested at /5c) psi for a <br /> total of --r tuts. <br /> WITNESSED BY Date <br /> "giature of occupant requesting gas service) <br /> INSTALLED BY --( j Date ///'S <br /> 3 <br /> (Signature of instilling gas fitter) f <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 />