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CITY OF EVERETT <br />PIPING TEST AFFIDAVIT <br />For, i -- I <br />Job Address 2 3 / ! 4 fh 5 % SC Permit No. e 6163- <br />The refrigerant line / natural / LP / medical gas system (circle one) was tested at psi for a <br />total of r minutes. <br />WITNESSED BY <br />(Signature of occ pan requesting gas service <br />INSTALLED BY <br />—(SttJmatDrrl� ga tttaT) <br />Date -(Qsj I Sim= <br />Date ptt.15'lOL <br />Please arrange for someone to be present on the date o' requested inspection to provide access for <br />fhe inspection. <br />REFRIGERANT CONTAINING PARTS OF THE SYSTEM THAT IS FIELD ERECTED SHALL BE TESTED FOR LEAK ATTEST PRESSURES NOT <br />LESS THAN THE LOWER OF THE DESIGN PRESSURES OR THE SETI ING OF THE PRESSURE RELIEF DEVICES. THE DESIGN PRESSURE <br />FOR TESTING SHALL BE THOSE LISTED ON THE CONDENSING UNIT OR COMPRESSOR UNIT NAMEPLAI E. (WAC 51.42.1108) <br />Hard Copy - Job Site <br />Pink Copy - Contractor White Copy - Inspector <br />