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CITY OF EVERETT <br />gr7- PIPING TEST AFFIDAVIT <br />Owner _ 42W-5AC1- <br />Job Address _ C),11 - Permit No. M I r <br />Th refrigerant line atural / LP / medical gas system (circle one) was tested at 3� psi for a <br />total of minutes. <br />WITNESSED BY���d�`!�-- Date114 <br />(Signature of occupant requesting gas service) <br />INSTALLED BY �`C <br />(Sign a of insta*g gas litter) � <br />Please arrange for someone to be present on the date <br />the inspection. <br />Date / VL jQ, -25( <br />requested inspection to provide access for <br />REFRIGERANT CONTAINING PARTS OF THE SYSTEM THAT IS FIELD ERECTED SHALL BE TESTED FOR LEAKS ATTEST PRESSURES NOT <br />LESS THAN THE LOWER OF THE DESIGN PRESSURES OR THE SETTING OF THE PRESSURE RELIEF DEVICES.: HE DESIGN PRESSURE <br />FOR TESTING SHALL BE THOSE LISTED ON THE CONDENSING UNIT OR COMPRESSOR UNIT NAME PLATE. (WAC 51.42-1108) <br />Hard Copy - Job Site Pink Copy - Contractor White Copy . Inspector <br />PWPTA (5117) <br />