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ever eci <br />' CITY OF <br />everett DATE � Co3 0 O <br />CITY HALL • EVERETT <br />CITY OF EVERETT <br />Le WASHINGTON 98201 <br />INSPECTION REPORT <br />Inspecting Department: <br />License Electrical _ Weights & Meas. <br />Fire Housing Engineering <br />Building Plumbing _— <br />Inspectors Signature. <br />Premises Inspected: <br />Type of Building or property <br />Location or Address <br />Items Inspected: <br />Items appearing to need add itional(in spection: Q <br />1 % ih-P11A, , in attendance on the Premises, <br />certify that the above inspection was made. <br />Signature <br />Form No. 424-001 Z <br />