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City of Stockton <br /> Fire Prevention Division <br /> 345 North EI Dorado Street <br /> Stocidon, CA 95202 <br /> (209) 937-8271 <br /> FIRE PERMIT AND SPECIAL INSPECTION APPLICATION <br /> tt �{ City County O r <br /> Permit No. t ` " 1 Date �t 0 <br /> Application is hereby made for a perrnittspecial inspection as required by the Stockton Municipal Code: <br /> ArUSec(s) Permit(s) Fee(s) <br /> Comments: Total Fee: <br /> V <br /> B-usmess a <br /> Address `"j ( ti"f i N /1'1 Ste. ZipT <br /> Telephone <br /> Contact Person Telephone <br /> Business Owner/Contractor �'�) c}C! �,� t �t� I U i 'C r "x-•.�` <br /> Address 'a -1 <br /> City/Zip '- Telephone ( - l <br /> I have read the above application and know the contents thereof;the same is true and correct I further state that I <br /> 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 /> � 6c <br /> .Applicants Signature:b( Ck# Amt <br /> Inspectedlissued by: Cod �iSA (city) R6 0 tco�,ryt <br /> Date Issued: ! t <br /> I <br /> 9 ;;,ni <br /> ::OOM1fA,GRPMSE,COS.FD.FD_V�f':3�5., <br /> FIRE PREVENTION DIVISION <br /> White: FPD File Goldenrod: Finance ---Green: FPO Deposits Pink: Customer <br />