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City of Stockton <br /> Fire Prevention Division <br /> 345 North F1 Dorado Street <br /> Stockton, CA 95202 <br /> (209) 937-8271 <br /> PERMIT AND SPECIAL INSPECTION APPLICATION <br /> City 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�N/��rZG 2a uND 7A-lVk f't Fitt?�,4 <br /> Comments: I 1 i000 085'PC OIL LIST Tota!Fee: Q <br /> 77(9C) E-5-tIOLN e_t.t) B ( L T <br /> Business Name-CAL a VeLCi A &!e1 a V<e t-dCA I <br /> Address 31 �t AQ0, - (te �o2 �11 c - t _ K 6v Ste. CA Zip <br /> Talephcne'o9 q iS - (031 (0 <br /> Contact Person U w Reg-'L4 Telephone zoel ' Q$3 S h- <br /> Business Owner 11.5 , QoS�MasCe rc -C 0 Qgvkiitac� 0 YV%cei2 zknA4 <br /> Billing Address 3 l 7S LS 2 t 3 <br /> City/Zip eS seas er qs 199 - Telephone ( 91p) <br /> ooso <br /> 1 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 City of Stockton Uniform Fra <br /> Code, and the amendrrthareof• and u of the Ppermit being applied for will conform to these practices. <br /> JKD !�5 owweerz <br /> Applicant's Signature Ate+,-T Code: 5A Ck# <br /> Amt. <br /> Inspected/Issued by: <br /> Date Issued: <br /> T:%RREPFeAF0RMSWEANITS.WPD <br /> White: File Yellow: Fre Co. Goldenrod: Check Green: FPO Pink: Customer <br />