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� CITY OF EVERETT <br /> PIPING TEST AFFIDAVIT <br /> Owner ����m7 <br /> Job Address C��y /�(-�f�,Q2L%7Z� Permit Na � -��� <br /> l "`ASTt= -r V�-�trr� ���2C <br /> The rek+�er�-+4+�e�Yna�aral Fk�-/ n circle one) wae tested at S' psi for a <br /> �otal oi I S minutes. 02 �►��'v�h rN�- r�vo F �v� f+� u��an�2, <br /> WITNESSED BY Date <br /> ( i nature o occupanl requeshng gas service <br /> INS'.-ALLED BY ��� Date 2- � 3 - 0'1 <br /> � �u � � <br /> Please arrange for someone to be present on the date oi requested inspection to provide access for <br /> the inspection. <br /> R[FRIG[RANT CONTAINING PAHTS OF THE S1'S1Eh1 THAT IS Fl[LD[RECTED SHALL�E TEST[D FGR LEAK AT TEST PRESSURES NOT <br /> L[SS THAN THE LOINER OF 7 HE DESIGN FRESSURES OR THE S[TTING OF THE PRESSURE RGLIEF DEVICES THE DESIGN PRFSSURE <br /> f-UR T[SiING SHALL 6E THUS[LIST[U ON TH[CON�ENSING UN�T OR COh7PRESSOR UNIT NAMEPLATE.(WAC 51-42-1108) <br /> Hard Copy - Job Site Pink Copy - Contractor Whiie Cepy- Inspector <br />