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CITY OF EVERETT <br />PIPING TEST AFFIDAVIT <br />y <br />owner ndJ�a(65 �In �IliL/ __ <br />Job Address Zu32 62WO ,a1113 _ _ Permit No. r�1SAS-og3 <br />11 <br />The refrigerant line / natural / LP / medical gas system (circle one) was tested at K psi for a <br />total of -<� minutes. <br />WITNESSED BY Date <br />-75lgnalur o occu trequeshn service <br />INSTALLED BY _ Ba� Date 7 r3-t <br />ture�T_ . 3 Te <br />� l.v <br />ti Please arrange for someone to be present on the dale of requested inspection to provide access for <br />J��A6 inspection. <br />REFRIGERANT CONTAINING PARTS OF THE SYSTEM THAT IS FIELD ERECTED SHALL BE TESTED FOR LEAK ATTEST PRESSURES NOT <br />LESS THAN THE LOWER OF TIIE DESIGN PRESSURES OR THE SETTING OF THE PRESSURE RELIEF DEVICES. THE DESIGN PRESSURE <br />FOR TESTING SHALL BE THOSE LISTED ON THE CONDENSING UNIT OR COMPRESSOR UNIT NAMEPLATE. (WAC 51-42-1100) <br />Hard Copy - Job Site Pink Copy - Contractor White Copy - Inspector <br />