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CITY OF EVERETT � <br /> PIPlNG TEST AFFIDAVIT ��. <br /> � <br /> Owner � r �5r 2 y r`� ,l v� � <br /> Job Address I� /� v � Permit No. �Q16 � ` 0 2_� <br /> � <br /> The refrigeran�e / natural / LP / medical gas system (circle one) was tested at / � psi for a <br /> total of_/�_ minutes. <br /> WITNESSED BY ,� �,� Of • '��� Date � <br /> -�ignat� y�re orpccu nt requestin as service <br /> INSTALLED BY �;(�,r�����,�� Date � � r� f�� � <br /> �5 f�l� �8 �rp���_- <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 THF SYSTEM THAT IS FIELD ERECTED SHALL BE TESTED FOR LEAK AT TEST PFESSURES NOT <br /> LESS THAN THE LOWER OF T:IE DESIGN PRESSURES OR THE SETTING O�THE PRESSURE RELIEF DEVICES. THE DESIGN PRESSURE <br /> FOR TESTING SHALL BE THOSE LISTED ON THE CONDENSING UNIT OR COMPRESSOR UNIT NAMEPLATE.(WAC 51•42-1108) <br /> Hard Copy—Job Site Pink Copy—Contractor White Copy— Inspector <br /> i <br />