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Owner <br />Job Address �" <br />CITY OF EVERETT <br />PIPING TEST AFFIDAVIT <br />Permit No. �� I "� � � � V <br />The refrigerant line / natural / LP / medical gas system (circle one) was tested at I� psi for a <br />total of � 5 minutes. <br />WITNESSED BY Date <br />ignature o oc upa t requesting gas service <br />INSTALLED BY ,� ' Date � Z - `� ) � <br />� <br />i ure i i i <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 />i <br />