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everett <br />,,e <br />THEEVERGREEN <br />CITY OF <br />everett <br />CITY HALL • EVERE77 <br />WASHING70N 98201 <br />7215 <br />DATE _ �"/ ?/% L <br />CITY OF EVERETT <br />INSPECTION REPORT <br />Inspecting Department: <br />License Electrical Weights & Meas. <br />Fire Housing Engineyring <br />Bu. Xng Plumbing J S ✓/ <br />Inspectors Signature <br />Premises Inspected: <br />Type of Building or property <br />Location or Address <br />i <br />Items Inspected: <br />Items appearing to need additional inspection: <br />I, , in attendance on the Premises, <br />Kkcertify that the above inspection was made. <br />Signature <br />Form No. 424-001 .0 <br />