Laserfiche WebLink
CITY OF EVERETT <br /> PIPING TEST AFFIDAVIT <br /> Owner <br /> Job Address Permit No. I�YJ l �Dn� - l�as <br /> . <br /> The refrigerant line / natural / LP / medical gas systQm (circle one) was tested at �Psi for a <br /> total of _1s� minutes. � �,,� <br /> WITNESSED B`'��� � " ' � Date l <br /> igna re o cupant requesting ga service Date <br /> INSTALLEDBY��,.n� �I --� <br /> Zstgnai <br /> Please arrange tor someone to be present on the date of requested inspection to provide access for <br /> the inspection. <br /> RE�RIGERANT CONTAINING PARTS OF THE SVSTEM THAT�S FIELD ERECTED SHALL 8E TESTED FOR LEAK AT TEST PRESSURES NOT <br /> • FOR TESTING SNAOLL BE TOHOSE LDISTED ON THE CONDE�NSING UNITIOR COMPRESSOR UN T NAMEPIATtC(WAC 5E D2 S;G�B PRESSURE <br /> Hard Copy —Job Site Pink Copy—Contractor White Copy—Inspector <br />