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evereft <br />THE EVERGREEN <br />CITY OF <br />ederett DATE,,e <br />CITY HAIL • EVERETr CITY OF EVERETT <br />WASHINGTON 98201 <br />INSPECTION REPORT <br />Inspecting Department: <br />License Electrical Weights & Meas. ' <br />Fire Housing Engineering <br />Building Plumbing <br />Inspectors Signature __S-JF--�'� <br />Premises Inspected: O <br />Type of Building or property <br />Location or Address l-s �a <br />' <br />Items Inspected: " <br />Items appearip9 toneeda ditional inspection: <br />A <br />i <br />ttrndance on the Premises, <br />certify that the above inspection was made. <br />Signature <br />Form No. 424-001 X <br />