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CITY OF EVERETT <br />PIPING TEST AFFIDAVIT <br />o�vnc� ��7 7�z'7z �t �� _/��?>, � L--� <br />Jot� Address ____�.��_�_� __ _ 1•,�_� m��=�__ Permit No. ���i 1'— � � � <br />TI-� � Ya5'l� �I- ;J-e n1'�`S i�?e�2 v�= i LL �� u� l�Ni-Zz-'n.. '�t'L��Zctu� <br />��Tl e refri��nl line / natural / LP / medicai �as system (cirde one wa tested at psi for <br />�,�-Qr r� c�� � �,�oYL A- M� N -�"l 1v1 � o�_ � 5�rt ►�. <br />WITNESSED BY <br />INSTALLED' � <br />�� <br />e�ccu{iy�if request�ny g;ts servico <br />-* ! � "� � Date <br />���tt���,-�����«>I�it� rt — <br />�I/ �/o �- <br />7/i�/� 7 <br />PI��;� :c ,�nan�e f�,r someone t.� t,e �xesent on the date oi requested inspoction to provide access for <br />�li�� inspection. <br />��:I i ��!Gf�:RAN1 CONTAI�JING PAHlS OF TH[ S'tSTI_M THA1 �S FIELD [fiGCTED SHALL �E TESTED FOR LEAK AT TEST PfiESSURES NOT <br />I �'��'.:. 1��4N THE LOWER OF TH[ OESIG�J PRESSUHES OR THE SL7TING OF THE PRFSSURE RELIEF DEVICES. THE DESIGN PRESSURE <br />'���+ : f t-, I iNG SHALL �E THOSE LIST[D ON THH COIJDENSING UNIT OR COh1PR[SSOR UNIT NAM[PLATE. (WAC 51 �42�11081 <br />Hard Copy - Job Site <br />Pink Copy - Coniractor White C�py - Inspector ;� C I� <br />