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�i�j?� CITY OF EVERETT <br />F PIPING TEST AFFIDAVIT <br />o�•��,��� _ - --- <br />Job Address -�L� �� l� �� �- � Permit No <br />� <br />C c? �t� z -ang <br />� <br />The re(riaerant line / iatural , LP / medical gas system (c�rcle one) was tested al �`� psi for a <br />total o( _I minute�.' ` <br />� / � z�r '��`� <br />�— Y I/ <br />INITNESSED BY '� � L�' I I Date <br />�' .'� — <br />—( i �ure o, occupant rej�luesting gas service <br />I�JSTALLEU Bv L �;��, .�t( ` i`' - Date ti- z�G C y <br />� i i r� Ttt � � <br />`�I�\� �( J �._� C:C;`"l li \`� <br />f'�„<isc ,�n��nye lor someone to be present on the date of requested inspection to provide access for <br />ihe ins� ���ction. <br />�+f � ��IGf Hn�JI CONTAINING PAHTS OP THC Sv5i:L1 1 rIN IS fl[LD [REGTf-D SHALL �E TESTED FOR LEAK AT TEST PR[SSURES NOT <br />I 1`.'�, 1 ri��': IHC LOWER OF TH[ IJI:SIGP! PRLSSUNf .`. GH IHP SFTTIIJG OF THE PH[SSURE PCLIEF DEVICES. THE DESIGN PRESSURE <br />i ��� :I ���';� ; SHALt. UG THOSE LISIf_f� ON 1HI �(�PIUENSING Ut:ll O(i C01.1PRESSOH UNIT NAh1EPlAT[ I�VAC St-42-1108) <br />H,�r�iC���ry JnbSii�: PinkCopy-Contractor Whi�eCopy-Inspector <br />