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477CITY OF EVERETT <br /> PIPING TEST AFFIDAVIT <br /> Owner <1% 1",./5/ <br /> e.---e3 <br /> f <br /> Job Address l 7 L 4"e L(_ jk Permit No. <br /> I <br /> The refrigeraTnatura . P/ medical gas system (circle one) was tested at /3 psi for a <br /> total of /I) min -es. ✓ <br /> WITNESSED BY ; __ <br /> . .// `I J <br /> Date <br /> h 0ia _ <br /> iignatur of occu -ting gas service) <br /> INSTALLED BY <br /> Date 3 1 (2-, 1 ( d <br /> (S gn ure of installing 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 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 />