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City of Stockton <br /> Fire Prevention Division <br /> r 345 North El Dorado Street, <br /> PREVENTION zosi s3�827s5zoz <br /> SAVESMES <br /> PERMIT AND SPECIAL INSPECTION APPLICATION <br /> /�� City County 1:1Permit No. 7 7"30Date z1 - 6 '-9 7 <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 /> 7gDl e. ks�6r eco <br /> f htax, ks <br /> Comments: Total Fee: q 66o' <br /> Business Name <br /> Address E r Ste. Zip <br /> Telephone <br /> Contact Person %�4 Telephone)'/ �2 <br /> Business Owner <br /> Billing Address <br /> City/Zip Telephone�269) 473 -o294 Z <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 <br /> l)thereof, and use of the permit being applied for will conform to these practices. <br /> applicant's Signature: WbgxLl ) Code: 5jA Ck# <br /> Amt. 1 '0d <br /> Inspected/Issued by: <br /> Date Issued: <br /> T:IFIREPRMFORMSTERM ITS.W PD <br /> White: File Yellow: Fire Co. Goldenrod: Check Green: FPD Pink: Customer <br />