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OB/U3/2007 07:58 FAX ��02/Uu2 <br /> CITY O�F EVERETT <br /> PIPING TEST AFFIDAVIT <br /> � `� /� �/ / <br /> Owner �"2 ►`t '�" �f�S�'i�t' f� I 1'v U-- <br /> Job Address � � '-1 � s� �r Permit No. M�� � �'��f� <br /> � The refrigerant Iine natura LP/ medical gas system (circle one) was tested at � � p,i for a <br /> - total of�_ minu� <br /> ' WI7NESSED BY � �2y.,. Date �( / 7/ o S <br /> i n re o occupant reques ing gas sen;ice <br /> INSTALLEDE3Y l� Date ��� ']�d� <br /> —(s �` tai a�Tm�---- — — <br /> Please arrange for someone to 6e present on tne date of requested inspection to provide access fer <br /> . the inspection. <br /> � fiEFRIGERaNT coNTA1NING PARTS oF 7NE SYSTEM THAT IS FlELD ERECTED SHALL�E 7ES7'EO FOR LFJ+KATTEST PRESSURES N.'f <br /> i � LESS THAN THE LOWER OF THE DESIGN PRESSURES OR THE 5[TTING OF THE PRF.SSUH[RELIEF DEVICES. THE DESIQN PRF.;iSURE <br /> FOR TESTING SHAIL BE THOSE USTED ON THE CONDENSING UNIT OR COMPqESSOR UNIT NAMEPUITE, (WAC 51-C2•1108) I <br /> Hard Capy—Job Site Pink Copy—Contractor Whlte Copy— Ir,spector � <br />