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CITY OF EVER{ETT <br /> PIPING TEST AFFIDAVIT <br /> Owner � � d � � (JCa�I/` � ��„ � <br /> Job Address f4 �� ' � �� �t�� _ Permit No. ���n 7CJ G� _ ��/CF <br /> �— <br /> The refrigerant li</natu�/ P / medical gas system (circle one) was tested at /� psi for a <br /> total of -J Z> minutes. � _ _ <br /> V��ITNESSED BY ��, �� ,�c�.�� Cate � �� �d� <br /> , ig,n re o occu��re uesdng gas serwce <br /> INSTALLED BY �"� >/-�, Date <br /> i f�iT�— <br /> Piease arrange for someone to be present on the date of requested inspection to provide access for <br /> the inspection. <br /> RGFRIGEfiANT CONTAINING PART.i OF THE SYSTEh1 THAT IS FIELD ERECTED SHALL BE TESTED FOR LEAK AT TEST PRESSURES NOT <br /> �_[SS THAN TH[LOWER OF THE UESIGN PRESSURES UR THE SETTING OF THE PRESSUFE RELIEF DEVICES. THE DESIGN PRESSURE <br /> FOR TESTING SHALL BE THOSE LIST[D ON THE CONDENSING UNIT OR COMPRESSOR UNIT NAMEPLATE.(WAC 51-d2-710d) <br /> Hard Copy–Job Site Pink Copy– Contractor White Copy– Inspector <br />