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�� CITY OF EVERETT <br />PIPING TEST AF�IDAVIT <br />o,�J�,�� �c:��`�����'1��2 — �� a� � � 15�. <br />' ,I � <br />Job Address _�� I � l� ('�—r L l�� �__ Permit No. c�� `l U�'OO� _ <br />l.JAS�� f!-r.�P UL�Ti SYSr�t� <br />The re€rigerarH-k+�e-/ , -s�s�e�-E��c'le-onej was tested at ',j psi for a <br />total of � � minutes. p2 ���-_� ~�'`5T 'T{{�6LlGt� 'j�j-�� "Ro��, <br />UJITNESSED BY <br />INSTALLEC [3Y <br />Date <br />ignatyre a occupant rr, stmg gas s c�-- <br />�, Date _�� <br />—(Siy� r i i �/' x�tl; r; i,', <br />Please arranye for someone to be present o�� the date of requested inspection to provide access for <br />Ihe inspection. <br />if.f=RIGEFANT CONTAINWG PARTS OF THE S' i Ii;�.I C f i!:I_U f'HP:( � f.0 SH��I.I. E3F 1E5'�ED FOH LEAK AT T[ST PRESSUR[; IJQT <br />.! SS THAN THE LOWER OF THE DESIGN FRESSUi'� 3 OP. 1 HL SI_1TING OF THF PI3[SSUH[ HELIEF DEVIC[S. THE DESiGN PRFSSUfiE <br />.���i; 1 C;TING SHALL 8E THOSE LISTED ON TH[ CONDENSMG UNIT OR COIdPRESSOH U�dIT NAt.1EPLATE �WAC 51-421108) <br />Ha: d Copy - Job Sit� Pink Copy - Contracto• White Copy - Inspector <br />