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CITY OF EVERETT <br />PIPING TEST AFFIDAVIT <br />Owner <br />Job Address 31%`1 5r LJ Permit No.—Da�- <br />The refrigerant line / naturals LP / medical gas system (circle one) was tested at 1_ psi for a <br />total of Cp_ mintes/ <br />WITNESSED BY �Wl� <br />(Signature of cup M¢4uesting gas sorvi ) <br />INSTALLED BY ?U�4 <br />(Signature of installing gas gas fitter) <br />Date z <br />Date 3--A2—/ <br />Please arrange for someone to be present on the date of requested inspection to provide access for <br />the inspection. <br />RCFRIGERANT CONTAINING PARTS OF THE SYSTEM THAT IS FIELD ERECTED SHALL BE TESTED FOR LEAKS ATTEST PRESSURES NOT <br />ESS THAN THE LOWER OF THE DESIGN PRESSURES OR THE SETTING OF THE PRESSURE RELIEF DEVICES. THE DESIGN PRESSURE <br />'OR TESTING SHALL BE THOSE LISTED ON THE CONDENSING UNIT OR COMPRESSOR UNIT NAME PLATE. (WAC 51.42-1108) <br />Hard Copy - Job Site Pink Copy - Contractor White Copy - Inspector <br />PWPTA (5/17) <br />