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ft <br />4w7r CITY OF EVERETT <br />PIPING TEST AFFIDAVIT <br />OwnerC �1-11L„� eoo V, <br />ff/i <br />Job Address Liq //� (( l 6 t_2LT A&-- 4Z,t� t 'i <br />Permit No. Vei G'// <br />The refrigerant line / natal / LP / medical gas system (circle one) was tested at / psi for a <br />total of � TT1inu s. <br />WITNESSED BY' ' Date �'L I Ciip <br />ature o up r uesung gas service <br />INSTALLED BY Date <br />Please arrange for someone to be present on the date of requested inspection to provide access for <br />the inspection. <br />REFRIGERANT CONTAINING PARTS OF THE SYSTEM THAT IS FIELD ERECTED SHALL BE TESTED FOR LEAK AT TEST PRESSURES NOT <br />LESS THAN THE LOWER OF THE DESIGN PRESSURES OR THE SETTING OF THE PRESSURE RELIEF DEVICES. THE DESIGN PRESSURE <br />FOR TESTING SHALL BE THOSE LISTED ON THE CONDENSING UNIT OR COMPRESSOR UNIT NAMEPLATE. (WAC 51-42.1108) <br />0 Hard Copy — Job Site Pink Copy — Contractor White Copy— Inspector <br />