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� <br />� <br />CITY OF EVERETT <br />�IrING TEST AFFIDAVIT <br />Owner H���`�� .� c� Yl c:►� �c v� <br />Job Address � �� l y � :��;� -, �1� �� _ Permit No. �Ttt*`t�` � �' y <br />The refrigerant line / nat a� LP / medical gas system (circle one) was tested at �_�psi for a <br />totai of � � minutes. , <br />WITNESSED BY /�;s� <br />ign ture o o pa t requesting gas service <br />INSTALLED BY <br />� � � � <br />�[� <br />Date <br />��'��'� ��/� <br />��, .- Z(� . / � <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 SET�fING 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 <br />Pink Copy — Contractor <br />White Copy — Inspector 7Z <br />