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CITY OF EVERETT <br /> PIPING TEST AFFIaAVIT <br /> Owner /�aa � L/isocr�� <br /> Job Address /Y zc, �����r � Permit No.'7Y1 n�/? - O 2 2 <br /> The refrigera�ne natur I / LP/ medical gas system (circle one) was tested at � psi for a <br /> ..---. <br /> total of ��_ minut�s� <br /> WITNESSED BY ,j .� , Date i:: -�s- a; <br /> �gn ture o occupant requesung gas service <br /> INSTALLED BY ��-�---� Date �z -�5-�� <br /> ,� �� s[�m�sg gas � <br /> Please arrange for someone to be present on the date of requested inspection to provide access for <br /> the inspection. <br /> REFRIGEHANT CONTAINi�JG PARTS OF THE SYSTEh1 THAT IS FIELD EIECTED SHALL BE TESTE�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 BE THOSE LISTED ON THE CONDENSING UNIT OR COMPRESSOR UNIT NAh7EPLATE.(WAC 51-42-1708) <br /> � Hard Copy - Job Site Pink Copy- Contractor White Copy- Inspector <br />