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CITY OF EVERETT <br /> PIPING TEST AFFIDAVIT <br /> Owner �,` ^r24�SA�--�A 1 ti� <br /> Job Address S O � � IT L.I�I . Permit No. M���- � �4 <br /> The refrigerant line/ atural LP/ medical gas system (circle one) was tested at /S psi for a <br /> total of �� minut s. <br /> WITNESSEDBY , ` Date �2 '��� <br /> na ure o occupa ques mg gas sernce <br /> INSTALLED BY �� Jj)L�� Date /1- <br /> ���� <br /> Please arrange for someone to be present on the date of requesled inspection to provide access for <br /> the inspection. <br /> 'REFFIGERANT CONTAININ6 PAPTS OF THE SVSTEM THAT IS FIELD ERECTED SHhLL 8E TESTED FOF LEAK AT TE6T PRESSURES NOT <br /> LESS THAN THE LOWER Of THE DESIGN PRESSURES OR THE SETTINO OF THE PrIESSUHE RELIEF DEVICES. THE DESION PRESSURE <br /> fOR TESTING SHALL BE THOSE LISTED ON THE CONOENSINO UNIT OR COMPRESSOR UNIT NAMEPIATE.(WAC 57•42•1 fOB) <br /> 1 Hard Copy—Job Site Pink Copy�-Contractor White Copy—Inspector <br />