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City of Stockton <br /> Fire Prevention Division <br /> 0 345 North El Dorado Street <br /> Stockton, CA 95202 <br /> f209) 937-8271 <br /> _PERMIT AND SPECIAL INSPECTION APPLICATION <br /> City � County ❑ (�W 49 <br /> Permit No. Date <br /> Application is hereby made for a permitispecial inspection as required by the Stockton Municipal Code: <br /> Art./Sec(s) Permit(s) Fees) <br /> 10 Z 74- Alk Ac�O�,4 c— <br /> Comments: I,uoo Ga ilov- 0aSTe Oi c iAS i Total Fee: CG <br /> 0 to P1.0 ( L T <br /> Business Name sucgoi L1' / Lic1 y lA i A ;Ncs ECA l t'•!7 <br /> Address 31 �( At2C� - (Iz�orz�c`c Gr` Ste CA Zip 9�Z�3 —�i <br /> Telephcne-0� Q�3 X31 (P <br /> Contact Person U Telephone 7-0q - ��3 - �. 3 l Z- <br /> p (3kaKa} <br /> Business Owner 11.5 , POs�ntias�e2 D Coti`t2ac� o ��tCeP- <br /> Qlna�} <br /> Billing Address 3-1-7S UvJ <br /> City/Zip WCsi ZaQZ'ANf^:60,S'19q - Telephone ( 91yf <br /> ooi a <br /> I have read the above application and know the contents thereof; the same is true and correct. I further state that <br /> I am familiar with accepted fire protection and prevention practices as set forth In the Clry of Stockton Uniform Pre <br /> Coda, and the amend thereof, and u qof thermit bang applied for w7 conform to those practices. <br /> O W n.E2�5 <br /> ODApplicant's Signature:\ 1 !45 ASK 1— Code: 5A Ckf1 <br /> Amt. <br /> Inspected/Issued by: <br /> Date Issued: <br /> T:LLRREPREVspa RMsv£nNirs.wFo <br /> White: File Yellow: Pre Co. Goldenrod: Check Green: FPD Pink: Customer <br />