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�' �--I � .� <br />Owner `_)�Z-�c=L� <br />Job Address 3 � I�__ <br />CITY OF EVERETT <br />PIPING TEST AFFIDAVIT <br />� <br />�1 <br />L 1� Permit No. N� l!� l� �- �/� <br />The refrigerant line / natural / LP / medical gas system (circle one) <br />� <br />total of _L�_ min es. <br />WITNESSED BY <br />(Signa re of ccu ant re ting gas service) <br />.� 4 <br />INSTALLED BY � ' � " `� � <br />� �__ �i � -�1.��� � � <br />(Signature of installing gas fitter) � <br />/ <br />was tested at l r� psi for a <br />Date ��--� I 2 � �� <br />Date 1_? � � � � 1,�, <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 Site Pink Copy - Contractor White Copy - Inspector <br />PWPTA (5/17) <br />