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CITY OF EVERETT <br /> PIPING TEST AFFIDAVIT <br /> Owner �d!��/1 L �J��/��' C�>�/-' S <br /> ,, '?- � j � � <br /> Job Address � � - � t�'( �� Permit No. � ��J I G.�Z <br /> The refrigerant line / natural / LP / medical gas system (circle one) was tested at Wv psi (or a <br /> i � <br /> total of �J� minu es.. <br /> WITNESSED BY � � ( � ,�.� / - l�r �✓ Date �-` �' ` <br /> i nat o cu �nt�iest�n a er�+c <br /> �'� rY "�`�� �� Date �/ /� � . <br /> INSTALLED BY �. ,�„ _ . ,/ <br /> , r� �fi'$i��irT�`�'�5 <br /> Please arranae for someone to be present on the date of requested inspection to provide access for <br /> the inspection. <br /> REFRIGERANT CONTAINING PARTS OF THE SYSTEfd THAT IS FIELD FRECTED SHALL BE TEST[D FOR LEAK AT TEST PRESSURES NOT <br /> LESS THAN THE LOWEF OF THE D[SIGN FRESSURES OF THE SETTING OF TH[PFESSURE RELIEF DEVICES. THE DESIGN PRESSURE <br /> FOR l GSTI!JG SHALL OE THOSE LISTED Ot�THE CONDENSING UNIT OR COPdPRESSOR UNIT NAW[PLATE.(WAC 51-42-1108) <br /> Hard Copy —Job Sile Pink Copy— Contractor White Copy— Inspector <br />