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CITY OF EVERETT <br /> PIPING TEST AFFIDAVIT <br /> Owner ,lJl�-/C+��e__��—���-- — ------- ---- — — <br /> Job Address <br /> 1 g� Qo2 C�ver- - - —Q�_(�C/� PermitNo. ��ID(� ' Olol.. <br /> The refrigerant line / natural / LP / medical gas s ste (circle one) was tested at _ psi for a <br /> VAcvu� 30 <br /> totai ot __ �iw�Ye�.��f�� (� ML� I�i�e / sa <br /> WITNESSED BY __. __— Date ,"l�' �� <br /> ,� e al oaupanl requesting gns service? <br /> INSTALLED BY �o�A I _�c�? CJ�,,q�/ Date��� <br /> (Signawrc ol m=_laliing gas t:�tcr) / <br /> Please arrange ior someone to be present on the date of requested inspection to provide access for <br /> the inspection. <br /> REFRIGERANT CONTAINING PARTS OF THE SVSTE�d THAT IS FIEIC ERECT�D SHALL�E T[STED FO:�LEAKS AT TEST PRESSURES NOT <br /> LESS TH.4N THE LOWER Of THE OESIGN PRESSURES OH THE SEnING OF TH[ PRESSUHE RELIEF DEVICES.TH[ DFSIGN PRESSURE <br /> FOR TESTING SHALL BE THOSE LISTED ON THE CONDENSWG UNR OR COMPRESSOR UNIT NAME PLATE.(W�C SL42-1lOB) <br /> Hard Copy - Job Site Pink Copy - Contractor White Copy - Inspector �I Z7� <br /> s� <br /> PWPTA(5/17) <br />