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CITY OF EVERETT <br /> PIPING TEST AFFIDAVIT <br /> Owner .{ A <br /> Job Address7 !!SJE v.t•c Permit No. <br /> IF <br /> The refrigerant line atural LP / medical gas system (circle one) was tested at psi for a <br /> total of -6Q — minutes. . <br /> WITNESSED BY ..rs' Date Q1 <br /> Ignature o occupant requesting gas service)INSTALLED BY ��`""" „"�"° Date <br /> -FrignalUTeOT Insfaring gas rarer <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 />