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CITY OF EVERETT <br /> PIPING TEST AFFIDAVIT <br /> Owner <br /> Job Address :2, O to L,c,S� G rA Permit No. m 1 Lo Oq 15 <br /> The refrigerant line / natural / LP / medical gas system (circle one) was tested at � psi for a <br /> total of minutes. <br /> WITNESSED BY �- % Date 1 y ` U <br /> (Signatur of occupant questing gas service) V <br /> INSTALLED BY AL Date <br /> (Signature of installing gas fitter) <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 LEAKS 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 NAME PLATE.(WAC 51-42-1108) �-— <br /> Hard Copy - Job Site Pink Copy - Contractor White Copy - Inspector �f <br /> PWPTA(5/17) ►. <br />