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���� CiTY OF EVERETT �v�ti <br />� PIPINU TES`f AFFIDA'VIT <br />O�:n��� _ -- - - - <br />Job Address <br />Permit No. <br />l-lie refrigerant line / natural / LP / medical gas system (circle one) was tested at � psi for a <br />' total of minutes. <br />WITNESSED BY Date _ <br />` igna ure o occupaN requesting yas service — �— <br />I IIJSTALLED 3Y Date <br />---�;�.�i����'r;i� 6 u n i <br />/ 3 <br />Ple,, :e r�nan�e for somcone to be present on the date of requested inspeciion to provide access for <br />th�� n��spection. <br />�"r ��IGFRANT CONTAINING PARTS OF THE SYSTEM TNAT IS FIELD ERECTC-D SHALL BE TESTED FOR LEAK AT TEST PRESSURES NOT <br />��" �+'•.!J THE LOWER OF THE DESIGN PRESSURES OR THE SETTING OF'fHE FRESSURE RFLIEF DEVICES. THE DESIGN PRFSSUPE <br />� �.. i It1G SHALL BE THOSE U3TED ON THE CONDENSING UNIT OR COMPRESS�R UNIT NAMEPLATE. (WAC 51-42•1108) <br />I; �,,; -„�,,; -- •1„�, ��i,; Pink Copy - Coniractor White Copy - Inspector <br />