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CITY OF EVERETT <br /> PIPING TEST AFFIDAVIT � <br /> Owner � <br /> Job Address �� G1�F3�� )n Permit No. _P'�) D7 Dy-L53� <br /> The refrigerant line / natural LP i medical gas system (ci�cle one) was tested at �_psi for a <br /> total of � minut . <br /> W ITNESSED BY__���� D� �l�0 Date ��LO '�d� — <br /> ( i na r . o occupant re g yas service <br /> INSTALLED BY Date '��-�-67 _ <br /> i r� i irtt � <br /> Please arrange for sorneone to be present on the date of requested inspection to provide access for <br /> the inspection. <br /> REFRIGEAANT CO��I;.'�VING PARiS Of-TIiC S',SrL�.t TH,\7 IS Fl[LU ERECTED SHALL BE TESTED FOR LEAK AT TEST PRESSURES NOT <br /> LESS THAN THL L01vE�� OF TfiE �[SIGN f�f;Cs:,uc�[5 OH TfiE SETTING OF THE PRESSURE RELIEF DEVICES. THE DESIGN PRESSURE <br /> FOR TESTING SHALL�[ THpS[ LISTEU ON 1 HL CONUC-NSING UNIT OR COh4PRES50R UNIT NAMEPLATE. (WAC 51-42-1108) � <br /> Hard Copy— Job Site <br /> Pink Copy— Contractor White Copy — Inspector I <br /> �I� <br />