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City of Stockton <br />Fire Pre ven tion Division <br />Irl _ 345 North EI Dorado Street <br />` Stockton, CA 95202 <br />(209) 937-8271 <br />PERMIT AND SPECIAL INSPECTION APPLICATION <br />City County d <br />Date <br />Permit.-.No./Z -l7' g 7 <br />Application is;;herebymade for a permit/special inspection as required by the Stockton Municipal Code: <br />Art./Sec(s) Permit (s) Fee(s) <br />Comments: • Tota/ Fee: <br />Business- Name '� <br />Address "t " 4: r Ste. Zip <br />Telephone- <br />Contact Person,---.. ti • Telephone 1 <br />City/Zip ";-t~:r�• " Telephone (. , <br />I have read:the- above. ~apphcation.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 Fire <br />Code, and the amendments thereof, and use of the permit being applied for will conform to these practices. <br />Applicant's SignaturCode: 5sA Ck# <br />Amt. <br />Inspected/lssued�by Q <br />` r i <br />Date Issued,?i 7 <br />T:IFIREPREV/1F(DWSN,l� HITS'.WPO f1 <br />e�ile ellaw Fire Co Goldenrod: Check Green: FPD (BION <br />IRE B <br />