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City of Stockton <br /> Fire Prevention Division <br /> 345 North El Dorado Street <br /> E <br /> (2109)) 937-827952021 <br /> PERMIT AND SPECIAL INSPECTION APPLICATION <br /> �.; City 12( 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 /> I I <br /> Comments: Total Fee: <br /> Business Name ' r <br /> Address1I kc �' �` ? Ste. Zip <br /> Telephone c- <br /> Contact Person 'moi'\ ( �c l L t Telephone ��"� •' 1~� ` )�� j <br /> Business Owner ,A l ; C' ,1 <br /> Billing Address ; <br /> City/Zip '�' tr"� E' "A <br /> Telephone <br /> C <br /> I have read the above application and know the contents thereof; the same is true and correct. 1 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,pe,rmit being applied for will conform to these practices. <br /> Applicant's Signature: .'`+ ( Al ek... (Y`.�.. Code' 5A Ck# <br /> "' `•�...rJ 1 ,ja t �`�� r—ter''' <br /> Inspected/Issued by: <br /> Date Issued: <br /> T:\FIREPREV\FORMS\PEAMITS.WPD <br /> FIRE PREVENTION QIVIS > t . <br /> ION ., zr <br /> White: File Yellow: Fire Co. Goldenrod: Check' Green:,FPD``' Pink:.Custor r: <br />