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everett Zht' <br />THE EVERGREEN <br />CITY OF <br />ederett DATE _Z%r' 7 <br />CITY HALL - EVERETT CITY OF EVERETT <br />WASHINGTON 99701 <br />INSPECTION REPORT <br />Inspecting Department: <br />License Electrical <br />Fire Housing <br />Building "c -- Plumbing <br />Inspectors Signature <br />Weights & Meas. <br />Engineering <br />Premises Inspected: <br />Type of Building or property <br />Location or Address U '% „QD _ <br />Items Inspected: �fZ7tif ,� x� <br />Items appearing to need additional inspection: <br />d OW /41r . <br />in attendance on the Premises, <br />certify that the above inspection was made. <br />Signature <br />Form No. 4]4 -001 :0 <br />