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05/17/2007 13:45 9163668631 S S PAGE 03/03 1 <br /> Stockton Fire Department ® Fire jPrevention Division <br /> 5 N. El Dorado Street • Stockton, CA 95202 <br /> (209) 937-8543 - FAX (209) 937-8893 <br /> FIRE PERMIT AMID SPECIAL INSPECTION LI TI <br /> Application is hereby made fora permit/special inspection as required by the Stockton Municipal Code.: <br /> Application Date: C Business Location: City : County:Contracted Area❑ <br /> Permit Number Permit Type Fee <br /> GM 3 <br /> •�41'` eft' f•: • Lit, 1. :.s:.. <br /> �%f a <br /> a <br /> Total Fee- <br /> 4-4" <br /> . <br /> , a <br /> COMMENTS: <br /> Business Name <br /> Address Suite Zip <br /> Business Telephone , <br /> " Contact Persona .:0 .. � � Telephone . . . . <br /> .Business Owner or Contractor <br /> Address _ Suite ._ City <br /> Business Telephone <br /> - <br /> Contact Person Telephone 64 al 17V <br /> (REQUIRED: Stockton Business License# Expiration Date <br /> ALL INFORMATION IS SUBJECT TO VERIFICATION.' <br /> I,have read the above application and know the contents.thereof,- the same is true and correct. I further <br /> state that I am familiar with accepted fire protection and preventative practices asset forth in the City of . <br /> Stockton Uniform Fire Code, and the amendments thereof, and use of the permit being applied for will <br /> conform to these practices. <br /> APPLICANT SIGNATURE <br /> Inspected/Issued by: <br /> Date Issued: CK# /e-�10 <br /> Pay Code: 5A $ zz Q `" CkY <br /> R6$_—. County <br /> RPWpP!(1.4h)."7 White FPI)File Yatln►w 0j.0nmer <br />