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CITY OF EVERETT <br /> PIPING TEST AFFIDAVIT <br /> Owner � (iL�T`7`_ � J-�Z �1 L'� i�-- <br /> Job Address � � ��� �� �"'�'"L Permit No. �h�iG2-O�( <br /> � <br /> Tl�e refrigerant line / natural / LP / medical gas system (circle one) was tested at � � psi for a <br /> total of �� minutes. . f <br /> WITNESSED BY � �!"� �, /"��" Date �- -K - O J <br /> ignature o cupant req esung gas service <br /> INSTA�LED BY _�i�� l�.C,�. �,��� �`Date � - b' - Cl � <br /> � i � =�' l.. <br /> Please arrange for someone to be present on the date of requested inspection to provide access for <br /> the inspection. <br /> REFRIGERANT CONTAINING PAFTS OF THE SYSTGM TH�T IS FIELD ERECTED SHALL BE TESTED FOR LEAK AT TEST PRESSURES NOT <br /> LESS THAN THE LOWER OF THE DESIGN PRESSURES OR�THE SETTING OF THE PRESSURE RELIEF DEVICES. THE DESIGN PRESSURE <br />� FOR TESTING SHALL 8[THOSE LISTED ON THE CON�ENSING UNIT OR COMPRESSOR UNIT NAMEPLATE.(WAC 51-42•1108) <br /> Hard Copy-Job Site Pink Copy-Contractor White Copy- Inspector <br />