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CITY OF EVERETT <br /> PlPI�VG TEST AFFIDAVIT <br /> owner L��� ��'� <br /> Job Address ��� �L�TI-I"L-'�. �/7 Permit No. /YJC�K��--d�7 <br /> The refrigerant lin / natural / P/ medical gas system (circle one) was tested at �psi for a <br /> total of � minutes. <br /> WITNESSED BY ��r��rpt. ,�,(,�T�� Date /-� -,� � - p�f <br /> �ture oi occ n}�eques pg gas service <br /> INSTALLED BY ,C��/�,���/ _��/ �� Date /�' �--�� <br /> —�siy�r��fr us���t;j ta <br /> i <br /> Please arrange (or sorneone to be present on ihe date of requested inspection to provide access for <br /> the inspection. <br /> HEFRIGERANT.^.ONTAINING PARTS OF TH[SVS�[t.1 TI-IAi�IS FIELD ERECTE�SHALL BE TESTED POR LEAK AT TEST PRESSURES NOT <br /> LESS THAN THE LOWEfl OF TNL DESIGN PRESSU!;[S OR THE SETTING OF THE PFESSURE RELIEF DEVICES. THE DESIGN PRESSURE <br /> POR TESTING ShHLL PF 7,✓,OSE LISTED ON THE CONDENSING UNIT OR COh1PRESSOR UWIT NAM1IEPLATE.(WAC 51-42-1108) <br /> Hard Copy-Job Site Pink Copy- Contractor White Copy- Inspector <br />