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Owner <br />CITY OF EVERETT <br />PIPING TEST AFFIDAVIT <br />i ,q0(o - <br />Job Address t I2 E 77— ' �/� .� lr , Permit No. '2�)D G4o /- zs n <br />The refrigerant line) natural / LP / medical gas system (circle one) was tested at az ti psi for a <br />total of minutes. <br />WITNESSED BY A � Daie — /Y — oG <br />1 ure of oWcc nt questln gas service <br />i <br />INSTALLED BY i � Date <br />tolymicurd <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 PRESSURES NOT <br />LESS THAN THE LOWER OF THE DESIGN PRESSURES OR THE SETTING OF 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 />