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CITY OF EVERETT <br /> PIPING TEST AFFIDAVIT <br /> Owner . l'.16.4fi -Atli 11 44 LJ _ _ice .. _ <br /> Job Address 47? if. �iezilwPermit No. /\/) /7/ ô !:7 <br /> The refrigerant line/ natural / LP / medical gas system (circle one) was tested at /0 psi for a <br /> total of /6-- <br /> min -s. <br /> WITNESSED BY Date 7/27--A)/8 <br /> (Signat - ooff ocp pa requesting gas service) <br /> INSTALLED BY ` Date 7/z ze/eg <br /> (Signature of installing ga ' er) / <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 <br /> PWPTA(5/17) <br />