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� <br />� <br />CITY OF EVERETT <br />PIPING TEST AFFIDAVIT <br />� � <br />Owner -��%'� L' � .N/•>T >ni <br />/� d <br />Job Address a �� �` !{/�� ""�'l ��' "t� /�L/�r Permit No. MQy//-CZ <br />The reirigerant line / natural / LP / medical gas system (circle one) was tested at �� psi for a <br />total of �5 minu e. � / <br />WITNESSED BY �.�' �f Date i/ �i 7��`� <br />ig ure o occu nt � quesung g��• serwce Date /� —/ 7—C� � <br />INSTALLEDBY ��.s�./ l•� �'' ----- <br />� <br />Please arrange for someone to be present on the date of requested inspection to provide access for <br />the inspection. <br />REFRIGERANT CONTAINING PARTS OF THE SVSTEM THAT IS FIEID EREI:TED SHALL BE TESTED FOR LEAK AT TEST PRESSURES NOT <br />FOR TEST NG SHAI1 BE TOHOSE LDIST D ON THE CONDENSING UN TIOR COOMPRESSOR Uh T NAMEPIATE. WAC SE DZ S�DB PRESSURE <br />Hard Copy - Job Site Pink Copy - <br />Contractor White Copy - Inspector <br />