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EXHIBIT C <br /> DIRE DL'PARTMENT <br /> _ (' 1 O�(F�S71Xt:KI'(NJ <br /> ,J�11 <br /> FIRE PREVINfION BUREAU <br /> CITY HALL Jura 3 1U3J \ <br /> 944-8271 ENVIkuMiENTAL HLALTH ppb <br /> APPLICATION FOR PERMITSPECIAL INSPECTION OR PLANEAPPROVALVICES N <br /> Application $ Permit No. (�(� 9 _ Date: <br /> Application is hereby made for a �/y, , as required by the <br /> Stockton fJunicipal Fire Code, <br /> Article (s) js <br /> Section (s) <br /> Rule ' <br /> Fee Schedule <br /> ee quire <br /> 'IBIS IS TO BE USED FOR TILE FOLLOWING PURPOSE(S) : <br /> -- <br /> LOCATION INHERE IS TO BE USED: <br /> OCCUPANT: <br /> ADDRESS: <br /> PHONE: <br /> : <br /> NAME OF OTHER PERSONS INVOLVED. (IDENTIFY CONTRACTOR, INSTALLER, ETC.) <br /> NAME: <br /> ADDRESS: / <br /> PHONE: <br /> I have read the above application and know the contents thereof: the same is true and <br /> correct. I further state that I am familiar with accepted fire protection and proven- <br /> tion practices as set forth in the City of Stockton Uniform Fire Code, and the amend- <br /> ments thereof, and that the use of the permit being applied for will conform to these <br /> practices. <br /> Signature f Kr , 3 <br /> FINANCE DEPT: INSPECTED BY: <br /> Pis collect rom1. <br /> Address �1 <br /> The sumo ollars 2. <br /> Finance De t. By: 3. <br /> Date: / �?fj ISSUED BY: �f `771E•,,� <br /> _ <br /> F.D.S 'd-985 DATE• I t/ 7 1 /LOi Gf/iTn�ssrP� <br /> Revised 5/22/74 /Pee <br />