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CITY OF EVERETT <br /> PIPING TEST AFFIDAVIT <br /> Owner <br /> Job Address 3O°3 Wesf �+S�H_n Rd Cl�.w�f�v✓r4 y�-p Permit No. �'�1 I`fo `L � `�y <br /> The reirigerant line/natural/ LP/medical gas system (circle one) was tested at (oov psi for a <br /> tota� ot lyN� minutes. <br /> WITNESSED Bll��,)erec �� 7uv Date Z 3 ��y <br /> gna �e o o upan reques rnce <br /> INSTALLED BY Da1e !Z�3�1�/ <br /> Piease artange for someone to be present on the date of requested inspection to provide access for <br /> the inspection. <br /> REFRIGEiUNT OOHTIUNING PMiS OF THE SYSTEM T11AT IS FlEID E71[CTID SNALL BE lE5iED FOR LEAK AT 7EST PHESSURES NOT <br /> LESS TTUW?HE LOWEJi OF THE DESIGN PRESSUR6 O(i T1E SETTiNC f�F THE PRESSt1RE RELIEF OEVK:EB. THE DESIGN PRESSURE <br /> FOR TFSTING Sf1At1.BE TT106[ILSTED OH TIE CONOENSING UNIT OR COMPR6.90R UNR NAMEF'LATE(M�I1C 51�42-1108) <br /> . Hard Copy—Job Site Pink Copy—Corrtractor Whito Copy—Inspedor <br />