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. 4 RECEIVES <br /> Fee . Stockton Fire Department • Fire Prevention Division 4 <br /> 345 N. EI Dorado Street, Stockton, CA 95202 APR 2 4 2015 <br /> ' (209) 937-8271 0 Fax (209) 937-8893 <br /> INSPECTION APPLICATION ENVIRONMENTAL <br /> A902fication is herebv made for a instiection as re uired LIV the Stockton Municipal Code. <br /> Applicant complete both sections below <br /> Application Date: a�— '- ,/.,? Location: City <br /> ,�q County ❑ <br /> Describe Type of Business/Services: /� l 4 - Ct' tJl-� jifnl�< <br /> Business Name Business Owner C clzrlizl <br /> �1 r <br /> Business Address �7 � `> �/�• l / t" Suite Zip `;^' -Ic <br /> Mailing Address w/ Suite Zip <br /> Business Telephone 2C,5 z4ry31 'e-.3 Contact Person AkV_e,_z 4/<.-C" <br /> __. <br /> E-Mail Address <br /> Inspection . - <br /> Check type of Inspection: W <br /> <�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: Ft/l(i��r7 e1 Ci <br /> /mss <br /> APPLICANT SIGNATURE -f DATE <br /> PRINT NAME: <br /> BELOW FOR OFFICE USE ONLY <br /> Issued by: Date Issued: <br /> Check# :�5 <br /> Y'.. Y• Jri <br /> F-1SpecialInspection -City: Pay Code XX$ }' 048-2631-342.23-00 <br /> ❑Special Inspection -County Contract Areas: Pay Code XX $ 048-2631-342.2310 <br /> ❑Permit and Code Compliance Inspection: Pay Code XX$ 048-2631-342.23-00 <br /> ❑Permit and Code Compliance Inspection after 2nd Inspection: Pay Code XX $ 048-2631-342.2300 <br /> ❑All other Field Inspections : Pay Code XX $ 048-2631-342.23-10 <br /> INSPECTION RESULTS: >� �• �'L' i� <br /> r— <br /> O <br /> L_tEL ty L yy1 <br />