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477- CITY OF EVERETT <br /> PIPING TEST AFFIDAVIT <br /> Owner Tom)N N6-1)Y <br /> Job Address 15.- 2 3 /3 2 RA STs' Permit No. D ` /b 8 <br /> The refrigerant natural LP / medical gas system (circle one) was tested at I psi for a <br /> total of 1 5 minutes. <br /> WITNESSED BY Date <br /> (Signature of occupant requesting gas service) <br /> INSTALLED BY Date7.d - - k? <br /> (Signature otaysteitinag 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 />