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°°,":‘ <br /> CITY OF EVERETT <br /> PIPING TEST AFFIDAVIT <br /> Owner F y 1' ''"C' <br /> Job Address 6' .. <br /> .t .. Permit No. \11 1 I -. <br /> The refrigerant linenaturai.t LP/ medical gas system (circle one) was tested at 0 psi for a <br /> total of t 10,vou.A <br /> WITNESSED BY 1:;*-Otws, p - Date it" - -, 1 <br /> (Signature cu ant requesting gas service) <br /> INSTALLED BY Date - I .. <br /> (5igna ailing 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 LEAK 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 NAMEPLATE.(WAC 51-42-1108) <br /> Hard Copy-Job Site Pink Copy- Contractor White Copy-Inspector <br />