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CITY OF EVERETT <br /> PIPING TEST AFFIDAVIT <br /> Owner <br /> Job Address <br /> `f 11 A L= 0L--=2 5 et/V 13L Permit No.� L (�� -- 0 <br /> The refrigerant line / natural / LP / medical gas system (circle one) was tested at psi for a <br /> total of minu <br /> WITNESSED BY Date <br /> /2 Z Z lZI- <br /> (Sign e o pant r questing gas service) <br /> INSTALLED BY �. vld DLe /4 / Date <br /> Signature of install g gas fitter) 1Xelitl <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 />