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CITY OF EVERETT <br />PIPING TEST AFFIDAVIT <br />owner ����C i <br />G%7 7 G�J� l/C" �� ��`� Permit No. /11 i�� -�� `- �1 <br />Job Address -- <br />The reirigerant line / natural ; LP % medica! gas system (circle one) was tested at _/ � psi (or a <br />total oi 'U minutes. <br />WITNESSED BY ' <br />( i�nawre oc �ant questing gas service <br />INSTALLED BY �/ // � t� — <br />�=�*-�i ,u�r�,�.r4���r,�t������i�: m��i - <br />Date <br />Date ���1 �� � <br />Please arrange for someone to Le present on the date of requested inspecfon to provide access for <br />the inspection. <br />�f-I-RIGERANT CONTAINING PARTS OP THE SVST[tA THAT IS RELD EPECT[D SHALL 6E TESTED FOR L[AK AT TEST PRESSURES NOT <br />P� f7 1�Sl� NG SHAOL,L 8E TOHOSE LDISTLD ON i HE CO�DONSING UN T IOR COOIdP(i[SSOR UN T NAA1EPlATE WAC 51-D2 StOB) PRESSURE <br />Hard Copy - Job Site Pink Copy - Coniractor White Copy - Insp��ctor <br />