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� <br />� <br />Owner <br />Job Address <br />CITY OF EVERETT <br />�I�ING TEST AFFI�AVIT <br />�14-��L�vi <br />�� <br />Permit No. � � ���-'�� ` �'� f � <br /><�. <br />The refrigerant line / natural / LP / medical gas system (circle one) was tested at �-.;;' psi for a <br />P� f� <br />total of �`�:r minutes. � , <br />WITNESSED BY �'r ��'� -� � <br />,�pr ,, Date ,a ,� <br />ignature o occupant requestmg gas service � Y <br />INSTALLED BY Date ,'� ,%�'•� ! -.' <br />i ur i i g s i r <br />Please arrange for someone to be present on the date of requested inspection to provide access fcr <br />the inspection. <br />. REFRIGERANT CONTAINING PARTS OF THE SYSTEh9 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 />