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CITY �F EVERETT <br /> PIPING TEST A�FIDAVIT <br /> Owner <br /> Job Address � y� �� � # � � Permit No��cO�� —Q� �o <br /> Lc�A�TE —E- V 1r�5 <br /> The r ' (circle one) was tested at 5 psi for a <br /> total of _ � � minutes. �� � � < <�"t''�� v� � W�''�-• <br /> WITNESSED BY ,�� Date r� I ILI C l : <br /> ignature o qccu ant re uesUng gas service • <br /> INSTALLED BY � ; I:, , , /1���/ ' <br /> Date -^ /c%�' <br /> —(stg�tai'tsar.�� u � � <br /> Please arrange tor someone to be present on the daie of requested inspection to provide access for <br /> the inspection. <br /> REFRIGERANT CONTAINING PARTS OF THE SYSTEM THAT IS FIELD ERECTED SHALL BE TESTED FOR LEAK AT TEST PRESSURES NOT <br /> L[SS THAN THE LOWEq OF THE DESIGN PRESSURES OR THE SETTING OF THE PRESSURE RELIEF DEVICES. THE DESIGN PRESSURE <br /> FOR TES7ING SHALL BE THOS[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 />