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CITY OF EVERETT <br /> PIPING TEST AFFIDAVIT <br /> Owner <br /> Job Address .A 00 yj V(. /'Z ., - ' � Permit No. <br /> The refrigerant line / natural / LP / medical gas system (circle one) was tested at ?C psi for a <br /> total of inut <br /> WITNESSED BY W ,t ,_ Date <br /> I u o c requesting gas service <br /> INSTALLED BY ,/' �' Date �l - <br /> (z5ignaTure OT inswiling gas TITFUr <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 />