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CITY OF EVERETT <br /> PIPING TEST AFFIDAVIT <br /> Owner ��4V��_S �(��O��-S <br /> Job Address � <br /> � �� / K (� �`�'� � �� � � �� Permit No. /" ! � �� ���- — �1��� <br /> The refrigerant line / natural P / medical gas system (circle one) was tested at �_psi for a <br /> total of I.� minutes. <br /> ����, <br /> WITNESSED�Y .- ' '�-.;� Date ��"'1 - �� <br /> �%Y�L�L[�9Lr ' ignatu"re ta ; upant requesting gas service <br /> INSTALLED BY ,�";.,..,;�����-- -- Date � - � - � 7 <br /> i r a i g s i e r <br /> i ----' <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 FRESSURES 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 />