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�w� CITY OF EVERETT <br /> -��r pIpING TEST AFFIDAVIT <br /> Owner ��� ��Q�I.�_ <br /> � <br /> Job Address /���� � R. "l/�Gti�l1=�0� I�U� . Permit No. �ZG�, - O(k�}�. <br /> The ret�igeranJne natural�LP/ medical gas system (circle one) was tested at ���5,psi for a <br /> total o: `%� minutes. <br /> WIT�'=SSED BY ��3� Date � /- 2 Z - 0 2 <br /> y�ature o pant reyuesting gas serwce <br /> INSTALLED BY �% T Date f�- �,7'� d ? <br /> ii u i i <br /> Please arrange (or someone to be present on the date of requested inspection to provide access for <br /> the inspection. <br /> 47FFRIGERANT CONTAINING PARTS OF THE SYST[M THAT IS FIELD EREC7ED SHALL BE iESTED FOR LEAK AT TEST PRESSURES NOT <br /> Lf_SS THAN THE LOWER OF THE DESIGN PRESSURES OR THE SETTING OF THE PRESSURE flELIEF DEVICES. THE DESIGN PRESSURE <br /> I ON T[STING SHALL BE THOSE LISTED ON THE CONDENSING UNIT OR COIdPRESSOR UNIT NAMEPLATE.(WAC 51-42•1108) <br /> Hard Copy-Job Site Pink Copy- Contractor W hite Copy- Inspector <br />