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City of Stockton <br /> Fire Prevention Division <br /> Irl .345 North El Dorado Street <br /> Stockton, CA 95202 <br /> NTIO (209) 937-8271 <br /> PERMIT AND SPECIAL INSPECTION APPLICATION <br /> City W County ❑ // <br /> Permit No. 9�- 9� Date 'Y -,30'9j, <br /> Application is hereby made for a permit/special inspection as required by the Stockton Municipal Code: <br /> Art./Sec(s) Permits) Fee(s) <br /> 7796L <br /> ed <br /> Comments Tota/Fee: <br /> Business Name\-lq LU)dA/0, ��A EGGDCLJ <br /> Address X120 0)-edt is JAS, Ste. Zip grS�13 <br /> Telephone -'166- 7000 <br /> Contact Person Telephone �r� <br /> easiness-owner <br /> Billing Address 1 <br /> City/Zip Telephone (5/0 ) S-M <br /> I have read the above application and know the contents thereof; the same is true and correct. 1 further state that <br /> I am familiar with accepted fire protection and prevention practices as set forth in the City of Stockton Uniform Fire <br /> Code, and the amendments thereof, and use of the permit being applied for will conform to these practices. <br /> Applicant's Signature: Code: 5A Ck# <br /> Amt. aw o0 <br /> Inspected/Issued by: <br /> Date Issued: <br /> T:\FIREPREV\FORMS\PERMITS.WPD <br /> White: File Yellow: Fire Co. Goldenrod: Check Green: FPD Pink: Customer <br />