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everett 5692 <br />THE EVERGREEN <br />CITY OF <br />everett DATE/e'�%— <br />,e CITY HAIL • EVERE❑ CITY OF EVEHETT <br />WASHINGTON 98201 <br />INSPECTION REPORT <br />Inspecting Department: <br />I <br />License Electrical Weights & Meas. <br />Fire Housing Engineering <br />Building � Plumbing / <br />Inspectors Signature r <�-- � <br />Premises Inspected: <br />Type of Building or property.?� <br />I <br />Location or Address '2 <br />Items Inspected:(?-jh <br />QItems appearing to need additional inspection: <br />�� //✓ er/l.O. (��<<.v�- C./,/.Gr,.c%v-4/� �:e.A LG oe-� <br />1,�2�L�o! ��_ , in attendance on the Premises, QR <br />certify that the above inspection was made. <br />Signature <br />Form No. 424-001 <br />