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CITY OF EVERETT <br /> PIPING TEST AFFIDAVIT <br /> Owner `� £ �.av cSy►1ar� <br /> Job Address 3 y�y �o''' � /4 Je EV�i�t UA m7-o/ Permit No. M X 603 660 <br /> The refrigerant line Catura / LP / medical gas system (circle one) was tested at psi for a <br /> total of /-�'O minutes. <br /> WITNESSED BY DateIZ4111,6 <br /> --(Signafure of occupant r uesting gas service <br /> INSTALLED BY �f f44 <br /> „ G� Date 3�Zy f 6 <br /> (Signalure of Installing gaS T <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 />