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FIRE DEPARTMENT �Zoo <br />C IN OF 511X',KIX)N <br />FIRE PREF-vi&r(w B[ :ATRI' I}u— <br />CITY HALL <br />944-8271 <br />APPLICATION FOR PERMIT, SPECIAL INSPECTION OR PLAN APPROVAL <br />Application $ Permit No. 0S- Date: ,- <br />Application is hereby made for a G12M t� as required by the <br />Stockton Akmicipal Fire Code, <br />Article (s) 11 <br />Section (s) <br />Rule Lu <br />Fee Schedule FeeRequired: <br />THIS ? �(LM t'1/ IS TO BE USED FOR THE FOLLOWING PURPOSES) <br />LOCATION WHERE T f 1 hIf' IS TO BE USED: <br />NAME OF 0THER PERSONS INVOLVED. <br />(IDENTIFY CONTRACTOR, INSTALLER, ETC.) <br />I have read the above application and know the contents thereof: the same is true and <br />correct. I further state that I am familiar with accepted fire protection and preven- <br />tion practices as set forth in the City of Stockton Uniform Fire Code, and the amend- <br />ments thereof, and that the use of the permit being applied for will conform to these <br />practices. <br />FINANCE DEPT: <br />Pls collect7rro <br />Address <br />The sumo � dollars <br />Finance D <br />Date: <br />F.D.s fd-985 <br />Revised 5/22/74 <br />1 <br />Applicant's <br />Signature: <br />Cz <br />INSPECTED BY: <br />2. v <br />3. <br />ISSUED BY: <br />DATE: <br />d <br />C <br />M <br />WA <br />