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, :. <br /> , <br /> CITY G'F EVERETT <br /> PIPING TEST AFFIDAVIT � <br /> I <br /> Owner �O�/ "�" f t-TL'�- � � x I <br /> Job Address �t ��� �--�'�' ►� �A70dc� Permit No. � C O�I Dg-ui(� � <br /> The refrigerant line / natura LP / medical gas system (circle one) was tested at _��psi for a � <br /> � <br /> toial of ��J minutes. <br /> WITNESSED BY —(,��y''�,. � Date Ip -z(�-OS <br /> �ture�owc�c�upant requesting gas service <br /> INSTALLED BY �.�y ��U� _ Date ��j.-a(o-�� , <br /> �rgn�r�at-nssratr`rrg-�as ' <br /> I <br /> Please arrange for someone to be present on the date of requested inspection to provide access for <br /> the inspeciion. <br /> REFRIGEFANT CONTAINIP�G PARTS OF THE SVSTEP.1 THAT IS FIELD ERECTED SHALL BE TESTED FOR LEAK AT TEST PRESSURES NOT <br /> l[SS THAN THE LOWER OF THE DESIGN FRESSURES OR THF SETTING OF THE PRESSURE RELIEF DEVICES. THE DESIGN PRESSURE <br /> FOR'1 ESTING SHALL BE TNOSE LISTED ON THG CONDENSING UNiT OR COh1PRESSOR UNIT NAMEPLATE.(WAC 51-42-1108) <br /> I ' � <br /> Hard Copy-Job Site Pink Copy- Contractor White Copy- Inspector :' - <br />