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GITY OF EVERETT <br /> "� PIPIIVG TEST AFFIDAVIT <br /> Owner �►" �' L�� � <br /> Job Address � � (�f'_Fi'1 Permit No. �/�� � /—���� <br /> The refrigerant line natural / LP / medical gas system (circle one) was tested at c�Ov psi for a <br /> total of �� minutes. , <br /> WITNESSED BY ����� Date p�. —/�— G�''j <br /> ��atu o occupant requesung yas service <br /> I��STALLED BY ��. � � Date �•Z.— �� <br /> —'(a�qnaevre d7�ir1'S��b i � � <br /> L <br /> Please arrange for someone to be present on the date of requested inspection to provide access for <br /> ihe inspection. <br /> REFRIGERANT CONTAINING PARTS OF THE SYSTEM THAT IS FIELD ERECTED SHALL 0E TESTED FOR LEAK AT TEST PRESSURES NOT <br /> LESS THAN THC L06VER OF THE DFSIGN PRESSURES OR THE SETTING OF THE PRESSUflE RELIEF D[VICES. THE DESIGN PRESSURE <br /> � FOR TESTING SHALL BE THOSE LISTED ON THE CONDENSING UNIT OR COMPRESSOR UNIT NAMEPLATt.(WAC 51-42-1108) <br /> Hard Copy—Job Site Pink Copy— Contractor White Copy— Inspector <br />