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� <br />CiTY Q1= EVERETT <br />PIPING TEST AFFIDAVIT <br />Ocn�er __����,�' rI <br />J�:b��.ldress �i� �,�7 LEZ��(.�iC%� J�� PermitNo. �.� /Dl `��C� <br />I�iir. it+fii����r�irit lii�.� <br />total of L� _ mir <br />WITNESSED B`( <br />INSTALLED E�l' <br />Pl�:��:;�:.urinyL <br />fl�e inspeciion. <br />� <br />/ m�dical gas system (circle one) was tested at �_S psi for a <br />aas <br />D a t e �-� �� �;' <br />Date �) •� > <br />someone to be present on the date of requested inspection to provide access for <br />�-,GFRIGEHANT CONTAIIJING PARTS OF THE SVSTEId THAT IS FIELD ER[CTED SHALL BE TESTED FOR LEAK AT TEST PRESSURES NOT <br />f f�:SS THAN T4E LOWER OF THE DESIGN PRESSURES UR THE SETTING OF THE PRESSURE R[LIEF DEVICES. THE DESIGN PHESSUP.E <br />f OR TESTING SHALL BE THOSE LISTED ON THE CONDFhSING UNIT OR COh1PRES50F UNIT NAPdEPLATE. (WAC 51-42�1100) <br />Hard Copy — JoL Site Pink Copy — Coniractor White Copy — Inspector <br />