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� <br /> CITY OF EVERETT <br /> PIPING TEST AFFIDAVIT <br /> Owner �uc �,3 �" ��"�� <br /> Job Address /� � �S �-y a� n2 • S t Permit No. �O l/o - 6 2Z <br /> The refrigerant line / natural / LP/ medical gas system (circle one) was tested at �psi for a <br /> total of �� minutes. • <br /> WITNESSED BY � ' Date � ;� u,2 <br /> ig ture o occ�pant reques ing gas ervice <br /> INSTALLED BY 7^� ;• : �? � ;,'y1�.7 Date f _ - ) - <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 SYSTEM THAT IS FIELD ERECTED SHALL BE TESTED FOR LEAK AT TEST PFESSURES NOT <br /> LESS THAN THE LOW ER OF THE DESIGN PRESSURES OR THE SETTING OF THE PRESSURE RELIEF DEb'ICES. 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 />