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grrCITY OF EVERETT <br /> PIPING TEST AFFIDAVIT <br /> Owner r <br /> Job Address L1 <br /> }A7 Permit No. <br /> The refrigerant line / natural / LP / medical eystem (circle one) was tested at psi for a <br /> total of. kS minutes. <br /> WITNESSED BY Lc) - Date `7/cP,3//7 <br /> (Sigfiature of occupant re uesting gas service) <br /> INSTALLED BY ' sV - ,,, gate <br /> (Signature of installing gas fitter) <br /> Please arrange for someone to be present on the date of requested inspectioh'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 RIE DESIGN PRESSU1 E <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 />