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� <br />�J <br />Owner <br />Job Address <br />CITY OF EVERETT <br />PIPING TEST AFFIDAVIT <br />Permit No. <br />l��/� -�? � <br />The refrigerant line / natural / LP / medical gas system (circle one) was tested at ��psi for a <br />total of �_ minutes. <br />WITNESSED BY Y'�,(, Date / <br />i o cc t requ sti gas service <br />INSTALLED BY t�� , ,� Date �'Z � �'� <br />Please arrange for someone to be present on the date of requested inspection to provide access for <br />the inspection. <br />REFRIGERANT CONTAINING PARTS OF THE SYSTEM THAT IS FIELD ERECTED SHALL BE TESTED FOR LEAK AT TEST PRESSURES hOT <br />LESS THAN THE LOWER OF THE DESIGN PRESSURES OR THE SETTING OF THE PRESSUhc RELIEF DEVICES. THE DESIGN PRESSURE <br />FOR TESTING SHA! L BE THOSE LISTED ON THE CONDENSING UNIT OR COMPRESSOR UNIT NAMEPLATE. (WAC 51-42-1708) <br />Hard Copy — Job Site Pink Copy — Contractor White Copy — Inspector <br />