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<br /> � CITY OF EVERETT
<br /> PIPING TEST AFFIDAVIT
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<br /> � u Address �� n ��L Permit No. '�1'J� � /
<br /> ,w,4 ,� i he refrigerant line / naturai LP/ medical gas system (circle one) was tested at �_psi for a
<br /> ,`�'" �tal of __f�__ minutes. -�
<br /> � +�'� :VITNESSED BY � �� �//,�-C'� Date 3 - Z c, `7
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<br /> ��--.. i ature o occupaht re uesung gas service .
<br /> ' r' INSTALLED BY �,p 7� ����,k,.� �,��=�,� Date 7 - � -�`�
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<br /> ` ; Please arrange for someone to be present on the date of requested inspection to provide access for ,_ „- ,
<br /> the inspection. ` ' "�'
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<br /> M �� REFRIGERANT CONTAINING PARTS OF THE SYSTE61 THAT IS FIELD ERECTED SHALL BE TESTED FOii LEAK AT TEST PRESSI�RES NGT .:
<br />� I_ESS THAN THE LOWER OF THE DESIGN FRESSURES OR THE SETTING Gf THE PRESSURE RELIEF DEVICES. THE DESIGN PRESSURE ;
<br />��t� FOR TESTING SHALL BE 7HOSE LISTED ON THE CONDENSING UNIT OR COMPRESSOF UNIT NAMEPLATE. (WAC 57-12�1 i081 � �
<br />� . ' Hard Copy—Job Site Pink Copy— Contractor White Copy— Inspector
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