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CITY OF EVERETT <br /> PIPING TEST AFFIDAVIT <br /> Owner �� �Z �OMgf��� � j����('�5'2�1J �%wK�i^� <br /> Job Address I �OZ Lv�t3 �2D. �vER lI GUfj'�Permit No. � OZ�C� •- US2 <br /> The refrigerant line / natural / LP / medical as system (circle one) was tested at /,� psi for a <br /> total of 2C7 minutes. � , -/- <br /> WITNESSED BY ' Date /� OU ZOt�3 <br /> atu occupant requesting gas service <br /> INSTALLED BY ,v Date /(�-�-,�773 <br /> u i i i <br /> Please arrange for someone to be present on th2 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 NOT <br /> LESS THAN THF LOWER OF THF DESIGN FRESSURES OR THE SETTING OF THE PRESSURE RELIEF DEVICES. THE DESIGN PRESSURE <br /> � FOR TESTING SHALL BE THOSE LISTED ON THE CONDENSING UNIT OR COMPRESSOR UNIT NAMEPLATE.(WAC 57-42-1108) <br /> - Hard Copy —Job Site Pink Copy— Contractor N�hite Copy— Inspector <br />