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CITY OF EVERETT <br /> PIPING TEST AFFIDAVIT <br /> C�vner <br /> Job Address Permit No. <br /> Tha refrigerant line / natural / LP/ medical gas system (circle one) was tested at psi for a <br /> total of minutes. <br /> WITNESSED BY Date <br /> ignature o occupant requesung gas service <br /> INSTALLED BY Date <br /> -(STjt5�1Tu u . < u , �� i u � • <br /> Please arranye (or someone to be present on the date of requested inspection to provide access for <br /> tl�e inspection. <br /> IiEPRIGERANT CONTAINING PARTS OF THE SYSTEA7 THAT IS FIELO ERECTED SHALL BE TESTED FOR LEAK AT TEST PRESSURES NOT <br /> LGSS THAN TNE LOWER OF THE DESIGN PRESSURES OR THE SETTING OF THE PRESSURE RELIEF DEVICES. THE DESIGN PRESSURE <br /> . f-OR TESTING SHALL OE THOSE I.ISTED ON THE CONDENSING UNIT OR COMPRESSOR UNIT NAMEPLATE.(WAC 51-42-1108) <br /> Hard Copy— Job Site Pink Copy— Contractor White Copy— Inspector <br />