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City of Stockton �R'� g �� <br /> Fire Prevention Division <br /> 345 North E/Dorado Street <br /> PREVED ply Stockton, CA 95202 <br /> NTION (209) 937-8271 <br /> MES-M PERMIT AND SPECIAL INSPECTION APPLICATION <br /> City 15wil County ❑ I <br /> Permit No. A)-/e^/ Date <br /> Application is hereby made for a permit/special inspection as required by the Stockton Municipal Code: <br /> Art./Sec(s) Permit(s) Feels) <br /> " <br /> Tota/Fee: <br /> Business Name <br /> a Address 1 . Y f "f>( iL dr _ ; Ste. Zip <br /> Telephone <br /> Contact Person 1- ) �'= d. Telephone/W-, fir'? <br /> A <br /> Business Owner '4,4,C { .f,c <br /> Billing Address r' >r . i f t i <br /> City/Zip f Telephone ( ) <br /> i <br /> I have read the above application and know the contents thereof; the same is true and correct. 1 further state that <br /> x' 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 /> IZDf 4 <br /> Applicant's Signature: Code: 5A.-6k� -•~ <br /> M <br /> Inspected/Issued by: (Q D <br /> Date Issued: APR <br /> T:\F1REPREV\F0RMS\PERM1TS.WPD <br /> ' FIRE PREVENTION DIVISION <br /> White: File Yellovy�Fire Co. Goldenrod: Check Green: FPD Pink: Customer <br /> s <br />