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CITY OF EVERETT <br /> � PIPING TEST AFFIDAVIT <br /> Owner T'r� v � �i/z /' � �� <br /> Job Addr�ss j� 3� �. �'+��•�� �' ��`� Permit No. X O�U J -Ov/ <br /> � __ ___ _--- --- . <br /> ��`.,. �fJ( eS3 W�fC W�.'+-.?,.. j)�� 'N-... _._ J <br /> �� <br /> The refrigerant line / natural / LP! medical gas system (circle one) was tested at ��psi for a <br /> total of �fJ mi utes. <br /> WITNESSED BY 4,� ti/'��� Date <br /> ignature o occupant requesung gas service <br /> INSTALLED BY � �� �� Date �j^�o7 <br /> —(5fgi�a`mr�arrrsstamts�ga�z "--- — '�--� <br /> Please arrange for someone to be present on the date of requested inspection to provide access for <br /> tlie inspection. <br /> fiEFRIGEFANT CONTAINING PARTS OF THE SYSTEM THAT IS FIELD ERECTED SHALL BE TESTED FOR LEAK AT TEST PRESSURES NOT <br /> L�SS TH:1N THE LOWER OF THE DESIGN PRESSURES OR THE SETTING OF THE PRESSURE RELIEF DEVICES. THE DESIGN PRESSUfiE <br /> FOR T[STING SHALL BE THOSE LISTED ON THE CONDENSING UNIT OR COh1PRE5SOR UNIT NAMEPLATE.(WAC 51-42•1108) <br /> ('f�" Hard Copy - Job Site Pink Copy- Contractor White Copy- Inspector <br /> � <br />