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*DEPT, <br />Stockton Fire Department • Fire Prevention Division <br />345 N. EI Dorado Street, Stockton, CA 95202 <br />(209) 937-8271 • Fax (209) 937-8893 <br />INSPECTION APPLICATION <br />is herebv made for a inspection as <br />RECEIVED <br />JAN 13 2014 <br />ENVIRONMENTAL HEALTH <br />PERMIT/SERVICES <br />Application Date: �/ / /�c / Location: Cit . County ❑ / <br />Describe Type of Bu <br />siness/Services: <br />'C • <br />Business Name TD- /� G/� Jc�'i'i�-Ti���usiness Owner,----??/ 779r <br />Business Address— CP f /i' - Suite _ _ Zip <br />Mailing Address ��� �G' u �Z�/ /� %/ % ( Suite Zip <br />Business Telephone2 t Z_2.)2 S Contact Person j�aJ ',/,'�,�_ <br />Check type of Inspection: <br />G] Special Inspection - City (charge per hour) <br />❑ Special Inspection - County Contract Areas (charge per hour) <br />❑ Permit and Code Compliance Inspection <br />❑ Permit and Code Compliance Inspection after 2nd Inspection (charge per hour) <br />❑ All other Field Inspections (charge per hour) <br />Describe purpose of Inspection: <br />APPLICANT SIGNA <br />PRINT NAME: <br />BELOW FOR OFFICE USE ONLY <br />Issued by: ,1 , ? I <br />DATE /7/3— � - <br />rIlrel >c <br />Check# .'1i I � <br />Special Inspection - City: Pay Code XX $ ?';'� _ 048-2631-342.23-00 <br />❑ Special Inspection - County Contract Areas: Pay Code XX $ 048-2631-342.23-10 <br />❑ Permit and Code Compliance Inspection: Pay Code XX $ 048-2631-342.23-00 <br />❑ Permit and Code Compliance Inspection after 24d Inspection: Pay Code XX $ 048-2631-342.23-00 <br />❑ All other Field Inspections : Pay Code XX $ 048-2631-342.23-10 <br />INSPECTION RESULTS: <br />INSPECTED BY: <br />DATE <br />09/08/09 FPD FORM Inspection Application White: FPD File Yellow: Inspection Results to Customer Pink: Payment Copy to Customer <br />