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4"7" CITY OF EVERETT <br /> PIPING TEST AFFIDAVIT <br /> Owner 00 V)4'tL. <br /> Job Address /5-03--- 06771 JLV p A/6r— Permit No. / VO - 0/7 <br /> The refrigerant line/ natural / LP/ medical gas system (circle one) was tested at /5 psi for a <br /> total of 30 minutes. <br /> WITNESSED BY s Date / / 151 7�G`� <br /> ( ignat ipa`nt questm ass i <br /> 9� <br /> INSTALLED BY6 �,G,r�-`� Date I I `5-`�kg <br /> (Signature o in ailing 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 LEAKS AT TEST PRESSURES NOT <br /> LESS THAN THE LOWER OF THE DESIGN PRESSURES OR THE SETTING OF THE PRESSURE RELIEF DEVICES.THE DESIGN PRESS <br />-_ FOR TESTING SHALL BE THOSE LISTED ON THE CONDENSING UNIT OR COMPRESSOR UNIT NAME PLATE.(WAC 51-42-1108) _ <br /> / D Hard Copy - Job Site Pink Copy- Contractor White Copy - Inspector 'M; ' <br /> * PWPTA(5/17) t <br />