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—� <br /> CITY OF EVERETT <br /> PIPING TEST AFFIDAVIT <br /> Owner c;�a�� "� l,(��;,. Js�,., <br /> Job Address Permit No. ��� �'� — � � <br /> The refrigerant line natural LP / medical gas system (circle one) was tested at 1 S� psi for a <br /> total of �� minutes. � � , <br /> , <br /> WITNESSED BY �'�r,�..%. L�___.._..ru.. � , <br /> Date �� � � - l � <br /> (Signature of occupant requesting gas se ice) <br /> � <br /> INSTALLED BY � Date I `�--'� '`!_ <br /> (Signat re of installing gas fitter) <br /> ..._ ��`ti1 , <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 �r��}' <br /> PWPTA(5/17) <br />