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CITY OF EVERETT <br />PIPING TEST AFFiDAVIT <br />Job Address '.XiS� k-c,��p�-r .�_ �'V L_ Permit No. % O-�o !0-02 � <br />�� �'e-� i �'�' �i � r_Ol <br />The refrigerant line / natural i LP / medical gas system (circle one) was tested at �psi for a <br />total of �'-� minutes. <br />WITNESSED BY <br />INSTALLED BY <br />Date � �Z y��_ <br />Date (y Zt.� <br />Please arrange for someone to be present on the date of requested inspection to provide access for <br />the inspection. <br />REFRIGERANT CONTAINIIJG PARTS OF THE SYSTEM THAT IS FIELD EREGTED 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 BE THOSE LISTED ON THE CONDENSING UNIT OA COMPRESSOR UNIT NAMEPLATE. (WAC 51-42-1108) <br />Hard Copy — Job Site <br />Pink Copy — Contractor White Copy — Inspector <br />