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I <br /> CITY OF EVERETT <br /> PIPING TEST AFFIDAVIT <br /> Owner "ZI !I <br /> Job Address 0i� • 1�( � `ei2, l�Z= Permit No. <br /> -73 <br /> The refrigerant line natural / P / medical gas system (circle one) was tested atpsi for a <br /> total of .20 minutes. <br /> WITNESSED BY Date r <br /> 7- <br /> (Sign ture of occupant requesting gas service) OO <br /> INSTALLED B 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 <br /> PWPTA(5/17) <br />