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CITY OF EVERETT <br /> PIPING TEST AfFIDAVIT � <br /> Owner �v /�{'v� �!� � t�1--c' <br /> Job Address . �� �ve �-t � - Permit No. �d ��� ' ��� <br /> The refrigerant line natural LP / medical gas system (circle one) was tested at � psi for a <br /> total of �� minute . <br /> � <br /> WITNESSED BY Date � �� ��� <br /> ,�° (Signature of occupa requesting gas serv' <br /> INSTALLED BY � � �'�..� � Date �;�,�—� g <br /> (Signature of i 'talling gas fitter) <br /> Please arrange for sorneone to be present on the date of requested inspection to provide access for <br /> the inspection. <br /> REFRIGERANT CONTAINING PARTS OFTHE 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 /> s ��� <br /> � Hard Copy - Job Site Pink Copy - Contractor White Copy - Inspector �� ,��- <br /> PWPTA(5/17) <� <br />