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City of Stockton <br /> Fire Prevention Division <br /> M,REVENT1­0N <br /> 345 North E/Dorado Street <br /> Stockton, CA 95202 <br /> (209) 937-8271 <br /> SAVES-MS <br /> PERMIT AND SPECIAL INSPECTION APPLICATION <br /> City 4 County ❑ <br /> Permit No. � Date <br /> Application is hereby made for a permit/special inspection as required by the Stockton Municipal Code: <br /> Art./Sec(s) Permit(s) Fee(s) <br /> Comments: �J �� <br /> TotalFee: <br /> 61 <br /> Business Name <br /> Address �Tt.3d � Ste_ . Zip <br /> Telephone - 9l <br /> ContPact Telephone <br /> Billing Address <br /> City/Zip 01-5 AU Telephone ,'9 ) — <br /> I have read the above application and know the contents thereof; the same is true and correct. I 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 /> -4D r�711Code: 5A <br /> Applicant's Signature: <br /> p G1ADIVISION <br /> Inspected/Issued by: DECDate Issued:T:WIREPREVTORMS\PERMITS.W PDFIRE PREV <br /> White: File Yellow: Fire Co. Goldenrod: Check Green: FPD Pink: Customer <br />