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CITY OF EVERETT <br /> PIPING TEST AFFIDAVIT <br /> Owner <br /> Job Address 1 J c( l 7 rt-1 �/� s� <br /> Permit No. � <br /> The refrigerant line / natural LP / medical gas system (circle one) was tested at <br /> e-- _ psi for a <br /> total Of _ minutes. , ' n <br /> WITNESSED BY 1�L�� <br /> Signature of occu ant re uestin Date <br /> P requesting gas service) <br /> INSTALLED BY <br /> (Signature of installing Date <br /> gas <br /> 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 Co <br /> PWPTA(5/17) py - Job Site Pink Copy - Contractor White Copy - Inspector `f <br />