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___ ,.. <br /> CITY OF EVERETT <br /> PIPING TEST AFFIDAVIT <br /> Owner <br /> Job Address � <br /> � Permit No. _� � �v� /--Q�� <br /> � <br /> The refrigerant I�/ natural / LP/ medical gas system (circle one) was tested at �_ psi for a <br /> total of �_ mi e . <br /> WITNESSED B� ` Date ����'/'CJ <br /> r (Sig�r afure of occupant requesting gas service) <br /> INSTALLED BY � 1C��1 � 1�) Date �'� � �� � <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 THOSEiISTED ON THE CONDENSING UNIT OR COMPRESSOR UNIT NAME PLATE.(WAC 51-42-1108) <br /> �J. �� <br /> Hard Copy - Job Site Pink Copy - Contractor White Copy-lnspector � <br /> PWPTA(5117) � � l <br /> �``,.-....� <br />