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4e77CITY OF EVERETT <br /> PIPING TEST AFFIDAVIT <br /> �r <br /> Owner . ...))(04.), <br /> Job Address Jo 1 1 /0 a ✓k kl' Permit No. r /6 l 2- - d 7ff <br /> The refrigerant line /aturaOLP/ medical gas system (circle one) was tested at /5 psi for a <br /> total of /5 minutes. <br /> WITNESSED BY 4, Date / -- 4 -- / 7 <br /> (Siature o occup nt requesting gas service) <br /> INSTALLED BY Date (p �- ( , <br /> (Si tur o f I g 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 /> Cay' ` <br />