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�,. <br />CITY OF EVERETT <br />PIPING TEST AFFIDAVIT <br />Owner `-� � ' � � ` ' ` r,� <br />Job Address ���(��� �C�r� r � 1�% Permit No. I� 1 � 7�5 ��� <br />The refrigerant line natur P/ medical gas system (circle one) was tested at �J psi for a <br />� <br />total of � minutes. —7 <br />WITNESSED BY ���,,�� t Date `rj i��' C� / <br />ignature o ccupant requesting gas service <br />INSTALLED BY �.�r n'(�,�(�i4�c�U`�� Date ,� �/ -(77 <br />� � „ � ��«y�-,v,-r� <br />Please arrange for someone to be present on the date of requested inspection to provide access for <br />the inspection. <br />REPRIGERANT COM�AINING PARTS OF THE SYSTEAi THAT IS FIELD ERECTED SHALL BE TESTED FOR LEAK AT TEST PRESSURES NOT <br />LESS THAN THE LOWER OF THE DESIGN PRESSUR[S OR THE SETTING OF THE PRESSURE RELIEF DEVICES. THE DESIGN PRESSURE <br />fOH TESTING SHALL BE THOSE LISTE� ON TH[ CONDENSING UNIT OR COIdPRESSOR UNIT NAIdEPIATE. (WAC 51-d2�1108) <br />Hard Copy - Job Site <br />Pink Copy - Contractor White Copy - Inspector <br />