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CITY OF EVERETT <br /> PIPING TEST AFFIDAVIT <br /> � , <br /> Owner ��'�' -� � � <br /> Job Address �' � � � ` �r/1 ���� ' � Permit No. of� �� � -�2 �� <br /> The refrigerant line / natural / LP / medical gas system (circle one) was tested at /L�--`�psi for a `- <br /> total of 3C� minutes. Gl � (�. O/�( L �cr�l�U/�L L 2{JO/t/` <br /> � L � <br /> WITNESSEDBY �� —�— p � � SJ <br /> ( ignature o uc � sting gas service Date �/=Z�-LocS <br /> INSTALLED BY 5���:-�'�-�' Date y- Zi• za�t <br /> ' —jii i i i <br /> Please arrange for someone t� be present on ihe date of requested inspection to provide access for <br /> the inspection. <br /> F�[l=RIGERAN7 CONTAINING PARTS OF THE SYSTEh1 THAT IS FIELD ERECTED SHALL BE TESTED FOR LEAK AT TEST PRESSURES NOT <br /> f1[SS TNAN THE LOLYER OF iHE DESIGN PRESSURES OR THE SETTING OF THE PRESSURE RELIEF DEVICES. THE OESIGN PRESSURE <br /> FOR 1 FSTING SHALI�E THOSE LISTED ON?HE CONDENSING UNIT OR CORIPRESSOR UNIT NAWEPLATE.(WAC 51-42-1108) <br /> Nar�J Copy-Job Site Pink Copy- Contractor White Copy- Inspector <br />