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Owner <br />Job Address <br />CITY OF EVERETT <br />PIPING TEST AFFIDAVIT <br />�r-� <br />___. <br />The refrigerant line / atural / LP / medical gas system (circle one) <br />total of �(, � mi e . _L:�-a� <br />WITNESSED BY <br />(SignaWm o1 occupam requesting gas service) <br />Permit No. /�/��d � <br />was tested at yo d psi for a <br />Date 7 — �� � � `� <br />INSTALLED BY � Date �-�6" �`i <br />(SignaWre ol installing gas litler) <br />Please arrange for someone ta be present on the date of requested inspection to provide access for <br />the inspection. <br />REFRIGERANT CONTAINI�lG PARTS OF THE SYSTEM THAT IS FIELD ERECTED SHALL BE TESTED FOR LEAKS AT TEST PRESSURES NOT <br />LESS THAN THE LOWER OF THE DESIGN PRESSURES OR THE SETTING OF THE PRESSURE FELIEF DEVICES. THE �ESIGN PRESSURE <br />FOR TESTING SHALL BE THOSE LISTEO ON THE CONDENSING UNIT OR COMPRESSOR UNIT NAME PLATE. (WAC 51-42-1108) <br />Hard Copy - Job Site Pink Copy - Contractor White Copy - Ins�ector <br />PWPTA (5/17) <br />