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� <br />� <br />Owner <br />CITY OF EVERETT <br />PIPING TEST AFFIDAVIT <br />Job Address �� �_ �j(' �� (�� Permit No. � ��'���� <br />Th refrigerant line / atural / LP / medical gas system (circle one) was tested at ��'� psi for a <br />total of minutes. -� • <br />WITNESSED BY���_.,.,,,� Date 7 �� � � '� ���' <br />(Signature of occupant requesting gas service) <br />� J� <br />INSTALLED BY ��,/�� i`�'��Y�` Date 1�` � �"- l� <br />� (Signature of installing as 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 � Pink Copy - Contractor White Copy - Inspector • <br />PWPTA (5/17) <br />