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CITY OF EVERETT <br /> PIPING TEST AFF�DAVIT <br /> �___ <br /> � / / <br /> Owner C./ _�'/. , - „���r,,, ��—�L L�'� <br /> � � � ---- <br /> Job Address _ � �v _�;```-5 % ��•`'''`�,�' `'��' ' � �� � Permit No. �L��6-���`/ <br /> The refrigerant line / naturai / LP / medical gas system (circle one) was tested at ��__ psi for a <br /> total of �� minutes.� <br /> VJI-i NESSED BY _ C.^_ ��^ -�� �, / �� Date 7�� /� 3 - <br /> (Siqm�re ol occupant requesting gas service) <br /> INSTALLED BY _ �� _ Date _�— z - �-3 <br /> �S�gna ure of inslalimg gas litt <br /> Please arrange for someoi�e to be present on the date of requested inspection to provide access for <br /> the inspection. <br /> HEFRIGERANT CONTAINING PARTS OF THE SVSTEM THAT IS FIELD ERECTED SHALL BE TESTED FOR LEAKS AT TEST PRESSURES NOT <br /> LESS THAN THE LOW��i OF THE DESIGN PRESSURES OR THE SETTING OF THE PRESSURE REUEF DEVICES.THE DESIGN PRCSSURE <br /> FOR T FSI�WG SHALL�E THOSE LISTED ON THE CONDENSING UNIT OR COMPRESSOR UNIT NAME PLATE.(WAC 57-42-1108) <br /> Hard Copy - Job Site Pink Copy - Contractor White Copy - Inspector <br /> PWPTA(Si17) <br />