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�, . <br />Owner <br />Job Address <br />. � <br />.- <br />CITY OF EVERETT <br />PIPING TEST AFFIDAVIT <br />� <br />r <br />I^5 oz ��,_f� OC.LcI�-LL Permit No. � dS�Z "'a3? <br />�l <br />T he refrigera line / natural / LP / medical system (circle one) was lested at <br />�i <br />� ...� <br />total of � m� iti:��_ >. �• <br />� <br />f �_psi for a <br />r� �<. .� � _�Z-�� <br />WITNESSCD BY � ),.✓y /\ Date <br />INSTALLED BY <br />I G, C <br />Date -�'- / _�__ <br />Please arrange for someone to be present on tf.e date oi requested inspection to provide access for <br />�he inspection. <br />FL-FRIGERANI Ci''<I '�";PC�1 I'ARl ti OF i I iE S1 til C L1 I I{.•�� iti fIELU GRECTf:D SNALL BE TESTEU FOR LC-AR AT TEST PRESSURES NOT <br />1 GSS THAN THL Lv::'EH UI- 1 HE pLSIGN f�f=.FS;! iHLS OH 11iE SCTTWG OF lHG PRESSURE RELIEF DEVICES THF DESIGN PRESSURE <br />FOH TESTING SHALL F3L TIIOSE LISTED ON 1 HF. CO�JDEIJSING UNIT OR COP.IPRESSOR UNIT NAIdEPLATG. I�YAC 51-42-1108) <br />Hard Copy — Job Sit� Pink Copy — Contractor White Copy — Inspector <br />