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CITY QF EVERETT <br /> PIPING TEST AFFIDAVIT <br /> owner �;��l�Ji�` /cZl� i��,� trL c_ <br /> Job Address ��f Z__ _��_) !-� 2 � �� Permit No. L � f n 3 `���% <br /> Sr� �- �� T-� �, r �i� � � /�� G��� <br /> Tiie refrigerant line / natural / LP / medical gas system (circle one) was tested at psi for a <br /> total of min <br /> C� <br /> WITNESSED BY � ✓�1/��1�;,'s�� Date �����%�U� <br /> i iature o occupant requesting gas service <br /> INSTALLED BY � Date <br /> i . i i <br /> Please arrange tor someone to be present on the date of requested inspection to provide access for <br /> the inspection. <br /> REFRIGERANT CONTAININu PARTS OF THG SYSTEP,1 THAT IS FI[LD ERECTED SHALL BE TESTED FOR LEAK AT TEST PRESSURES NOT <br /> LESS TW1N THE LOLVER OF THE DESIGN PRESSURES OR THE SETTING OF THE PRESSURE RELIEF DEVICES. THE DESIGN PRESSURE <br /> FOfi T[STING SHALL BE THOSE LISTED ON THE CONDENSING UNIT OR COMPFESSOR UNIT NAMEPLATE.(WAC 51-42-1108) <br /> Hard Copy —Job Site Pink Copy— Contractor White Copy— Inspector <br />