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grrCITY OF EVERETT <br /> PIPING TEST AFFIDAVIT <br /> Owner Kv/1/4e- c6i 6 <br /> Job Address Ai a.`kk-se\. eiv' 5 _ Permit No. \I 3 <br /> The refrigerant line /1 / LP / medical gas system (circle one) was tested at Jc psi for a <br /> total of .,Arf) minutes. <br /> WITNESSED BY Date `'441/1 <br /> (Signature of occupant requesting gas service) <br /> INSTALLED BY Derif-0 AGC-11 1S Date Z // 6/ f $ <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 OV <br /> PWPTA(5/17) <br />