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�� <br />CIl �f OF EVERETT <br />PIPING TEST AFFID�iVIT <br />Owner �J�U� 1� i-��4'Mr�C�-k-' <br />Job Address �� z. v���Kt�.cJ u� ,�u Permit Na /1'C75'r//- C�� <br />The refrigerant line / natural / LP / medical gas system (circle one) was tested at �_psi for a <br />total of�C minute '���� � 4��� /� <br />WITNESSED BY ,� �� • � ..,c� /'�-- <br />i wre o occupant requesting gas service, <br />INSTALLED BY < < /1r , /IZc�E <br />in i <br />Data /i%y � n� <br />Date ��_ pg _p � <br />Please arrange for someone to be present on the date of requested inspection to provide access for <br />the inspection. <br />REFRIGERANT CONTAINING PAHTS OF THE SYSTEM THAT IS FIELD ERECTED SHALL BE TESTED FOR LEAK AT TEST PRESSURES NOT <br />LESS THAN THE LOWER OF THE DESIGN FRESSURES OR THE SEITING OF THE PRESSURE REL�EF DEVICES. THE DESIGN PRESSURE <br />FOR TESTING SHALL BE THOSE LISTED ON THE CONDENSING UNIT OR COMPRESSOR UNIT NAMEPLATE. (WAC 51•42•1108) <br />Hard Copy — Job Site Pink Copy — Contractor Whitc Copy — Inspector <br />