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CITY OF EVERETT �-J <br />�� <br />PIPING TEST AFFIDAVIT <br />Owner ._ ����.��: �"� <br />�1 ,� /�--- - --- /1�, <br />Job Address -_-�-�I �� �ll���--._ _ -----_.. Permit No. Ld„�7� �� � <br />�� F"� � TZ` �3- �� 1�''r`J l.�e Q�� l O� f�i L� L� D�- <br />The r � � rcte-ottej.�eris tested at pei�e�r- <br />total of _ � �__ minutes. �'`���'n� <br />, f- <br />WITNESSED BY �1 �' Cu � _ —S - � Date � �/ `�i n � <br />�ignaWrc o o,cupafimques�mg u;ts serwco�— <br />INSTALLED E3Y Date <br />,n —TSt�taturrs�rt�stn7imz��ssti <br />�� .7�sdn s ka h � rs <br />Ple�se auange for someone to lm, E�resent on the date of requested inspection to provide access for <br />the inspection. <br />R[fRIG[RANT CONTAINING PAR75 OF THE SVSTL�d THAT IS FlELD [RGCTEO SHALL �E TESTEO FOR LEAK AT TEST PpES5UPE5 NOT <br />1.E55 THAN 7H[ LOWfR OF TH[ OESIGN PRESSURES OR THE SETTING OF THE PRESSURE RELIEF DEVICES. THE DESIGN PqESSURE <br />( fON ; CSTING SHAL L �E THOSE LISTGD OV THE CONDENSING UNIT OR COMPRFSSOFi UNIi NAMEPLATE. (WAC 51 �42�1108) <br />Hard C:opV - Job Sitn Pmk Copy - Contractor White Copy - Inspector <br />