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r�resit Stockton Fire Department•Fire Prevention Division <br /> /sAh3�\ 345 N.EI Dorado Street,Stockton,CA 95202 <br /> (209)937.8271 •Fax(209)937-8893 AUG 15 2013 <br /> INSPECTION APPLICATION <br /> By— <br /> A rlication is hereb made tdr a ins tion as oired b the Stockton Municipal Coda. <br /> Applicant complete both sections below <br /> Application Date Location: Cily� County❑ <br /> Describe Type of BusinaselServi(ne�es: \' 1 OV�1 S /' RECE�VE <br /> Business Name�yt'1,�^1I 1/11 Nu. (-11 '` Business Owner 1 I Y (�S <br /> Business Address l LCjo - V V 111oVI wV`y Suite zap 016�uJ <br /> Mailing Address 13111p �YY1RPklT,t,1 tiirnh �zraP3Q1�7Q. FEB 2. G "''t <br /> Business Telephone�Z-�ZI- QCentacI rawt Y7f IVWiI� <br /> E-Mail Address (3_ r rjs '-vir�hy l.rom ENVIRONMENTAL <br /> Inspection Type HEALTH DEPARTMENT <br /> Check type of Inspection: <br /> ❑Special Inspection-City(charge per howl <br /> ❑Special Inspection-County Contract Areas(charge per hour) <br /> ❑Permit and Code Compliance inspection <br /> ❑Permit and Code Compliance inspection atter Zee Inspection(charge per hour) <br /> ❑All other Field Inspections(charge per hour) <br /> Dec eU ose fl ection: L1r <br /> Pt <br /> APPLICANT SIGNATURE DATE <br /> - <br /> PRINT PRINT NAME: A(P <br /> BELOW FOR OFFICE USE ONLY <br /> Issued . Date ssu v <br /> Cheokr of ern - <br /> tt . <br /> pacial lospec8pn-City.Pay Code XX S,5n - 04a-2631-34223-00 -14-1 <br /> ❑Bpecoilnspeclian-Gowdy ConimctAmas.Pay Code XXS 0411-2631-3422310 <br /> ❑Permitand Code Complianuinspection:Pay Code XXS 048-263134223-M <br /> ❑permit and Cale Compliance Inspection after V lnspedow. Pay Code XXS 048.2831342.23-00 <br /> []Alt other Fuld Inspections: Pay Cade XXS 048-2631-34223-11D <br /> INSPECTION RESULTS: <br /> VLPS- 3ho Y Pc ,i, p <br /> lic�pa <br /> S <br /> 7 717t <br /> IzG � r <br /> INSPECTED BY: DATE <br /> OM09 FPC FORM lmPuki.9P0cenn Whik:FPDRe Ytllwlnspeia:nRMft(a Cu.4dnrr Pmk Fa)mct Copyro Coecnrer <br />