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r <br />Rti "�i �t.� S�•.: J� <br />"� 4.�x <br />h.�; ;; w ..;.� r � . <br />H'i� :C y ji � {� ��� <br />" kt ° f p '{oN '� <br />,Y .�� � r i..; <br />- t, � t yp �s, �� y. <br />..:r*, �:r� � `i:` ,,.';, <br />,�' <br />�;� ;3�` <br />�/ <br />Owner .�j��f <br />Job Address f721 VN., <br />CITY OF EVERET� <br />PIPING TEST AFFIDAVIT <br />��'q�1�PermitNo. �67G2-o/(p <br />ST�9L/1 7Z T o� <br />��9yr-� v�ivr- <br />The refrigerant �ine / natural / LP / medical gas system (circle one) was tested at psi for a <br />total of �_� minutes. �"/`�� TES? d/�t <br />� y �— Date �l�3-TE/Z L.'/�r C�� <br />WITNESSED BY� � � �, 6 � <br />ure e ant re sling gas service <br />If�15TALLED BY �/ Date 8,�6�i� � <br />�� <br />Please arrange for someone to be present on the date of requested inspection to provide access for <br />the inspection. <br />R[FRIGERANT CONTAINING PARTS OF THE 5YSTEh1 THAT IS FIELD ERECTED SHALL BE TESTED FOF LEAK AT TEST PRESSURES NOT <br />LESS THAN THE LOWER OF THE DESIGN PRESSURES OR THE SETTING OF THE PRESSURE RELIEF DEVICES. THE DESIGN PRESSURE <br />FOR TESTING SHALL BE THOSE LISTED ON THE CONDENSING UPJIT OR COMPRESSOR UNIT NAMEPLATE. (WAC 51-42-1108) <br />`{.�� Hard Copy — Job Site Pink Copy — Contractor W hite Copy — Inspector <br />\�' <br />