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everett <br />THEEVERGREEN <br />CITY OF <br />evereit <br />CIiY HAIl • EVERETi <br />WASMINGTON 902J7 <br />/ <br />'-� L� �� � I <br />DATE - y � Z-7 - � .C.-.. . <br />cirvor- _:Er��r� <br />INSPEC1lON RFP9�'.i <br />Inspecting Department: <br />LiCense __ Elec�iical _____._ Weinht� F� ?:4ras. <br />Fire Housing Enginecnng <br />Buildiny . Plumbing <br />Inspectors Signature _— �_ �����:�� �-------- --- <br />Premises Inspected: �`��� <br />/ <br />Type of Building or property <br />Location or Address � C�o C� �',,,_.� <br />--- ----. ._------- <br />Items Inspected: � <br />��� <br />Items appeariikf to need additional inspection: <br />L <br />� � - � �� �.�, <br />0 <br />I, ____ __ , in attendancr, on ihe Premises, <br />certiiy that the abvre insPe� tion was made. <br />Signature _____ _ <br />Fo,,,� N��. q�a oot = <br />