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grrCITY OF EVERETT <br /> PIPING TEST AFFIDAVIT <br /> Owner MtG Yd lk-t I / 1 <br /> Ptvl <br /> Job Address o (1/6----- MU1I. (11-25D 61(lb Permit No. C, /5-7069 _0* <br /> The refrigerant line /natural /\ P / medical gas system (circle one) was tested at !S psi for a <br /> total of 12-0 minutes. 9/ <br /> WITNESSED BY / <br /> A Date 15- Z 01 <br /> (Signature of occupant reques ng gas service) <br /> INSTALLED BY �� , . i. 0 - Date(Signature ' if(4- <br /> 15 <br /> 1 .2011 <br /> of i ti;',-as 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) j <br /> 1 77 41 <br /> Hard Copy - Job Site Pink Copy - Contractor White Copy- InspectorV V If <br /> 'f PWPTA(5/17) "" <br />