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00;L CITY OF EVERETT <br /> PIPING TEST AFFIDAVIT <br /> t 1 l/ <br /> Owner 1y wolj <br /> Job Addressa7Permit No. ' <br /> The refrigerant linenatura / LP/ medical gas system (circle one) was tested at psi for a <br /> total of minu e .I <br /> WITNESSED BY Date a��ly/zv17 <br /> nature o o upat uesting gas servic <br /> ya e <br /> INSTALLED BY41'7 - Date <br /> ignafure OT InSTaiing 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 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 />