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� �.ITY nF EVERETT <br /> �'�'T PIPING TEST AFFIDAVIT <br /> o,���,��� �� R r� ��, ? �-.� L C -�/?_ <br /> Job Address _ _ _�Z % ����L�L �! �w Permit No. �7� �s '�/Z n >2_ <br /> Tl�e �ef�i�er�nt line ; natural LP / medical gas system (circle one) was tested at �psi ior a <br /> total ot � '�_ minutes. <br /> � �,NITNESSED BY ' Date lr�- /j' �'S <br /> � iS'gfi�ture�upan eques ng gas service <br /> IiJSTALLED BY I��: , �,'�.��1( �( - — Date �a � � -U � <br /> ,.s. <br /> �� �;:�iiw�.��ri:,�,�'� � ,;�,��::r�r�•�� <br /> ;�;i:.isz� ,ur.inyc (or someono to In� ��ras��nt un the date of requested inspection to provide access for <br /> tlr_: inspection. <br /> iJ. i I?IGERANT CONTAINING PARTS OP THE SYSTEh1 THAT IS FIELD ERECTED SHFLL BE TESTED FOR IEAK AT TE57 PPESSURES NOT <br /> I ! ','.7 THAN THE LOWER OF THE DESIGN PRESSURES OH �NE SETTING CF TME PRESSUR[RELIEF DEVICES. l H[ DESIGN PRESSUPF <br /> ' � �f-STING SFiALL�E THOSE LIST[D ON THE-CONDENSING UNIT OR COh9PRES:;OR UNIT NAM11[PLATE �l1'AC 51�42�1108) <br /> �1` <br /> �v Fi�i�d Co��y - Job SIt�� Puih Capy - ��i�ir�actor White Copy- Inspector <br />