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���� <br />CITY OF EVERETT <br />PIPING YEST AFFIDAVIT <br />,, <br />Owner /�� o 1:�, !� �,/ ; ; <br />Job Address ��l � iP��/-'� � F'ermit No <br />The refrigerant line i�natural �LP i medical gas system (circle one) was tested at <br />lotal of _1 " . _ minules. � - , <br />,� , . <br />� <br />•� ��/���_ ��•/ <br />i psi for a <br />WITNESSED BY `', ,.,�j�. !_„��,�,, ;%' � r � Date �Z (J� <br />iy ature u nccup �que, mg < s service — <br />INSTALLED BY % � �,,, / �Y! Date , <br />-�� r�trn�arnssr�i r�i�cj�j�s�rtr�rT--- ''1=-'--' r�� <br />PleaSe arfan�ae hn ;rnrn��>n�� �„ �,�� �u,,;,�r�l ��n the �Iritc� uf re��u�sted inspection to provide access for <br />the inspection <br />(1F.FRIGERANIt�'.I:.�',i':�.i:.l�'� .'� i�y �. il�'i��:l...ii,l�.!I�I� II; �-II:.II Hf II>IEI�I�IHlf,lh.�l tfSIPRFStiUHF5rl01 <br />LESS THAN illl t°�:.! I�. � I I rf! I�I -.i� �'. i 9. .i ��.i .. �I+ UII �.I I I�'n, � i !14 Pl�f >;>UH[ NI I I�f II! :li�.f b 1HF UF51 ,ry PNPSSURE <br />FO(i TFSTING SUAI I ffl I i u�� ��1 1 r�' 1 I: i rt� I1�I �� .i>!,UI t�51r�i; UrJi f UH r� )fJPHtSs�)P UhI I NAI.tF Pli. i F I W �C 51-J2-ni iRi <br />Hard Copy - Job Sit� <br />Pink Co�iy Cnnir:�ctnr White Copy - Insper,Ior <br />