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M T1 � p > <br /> CL <br /> O m " <br /> v O � W <br /> W <br /> vrI <br /> O oc ton Fire Department • Fire Prevention Division C) (Jl <br /> N A .esA 345 N . EI Dorado Sheets Stockton , CA 95202 ' C� 1 .A. <br /> O N O <br /> `l Y (209) 937-8271 • Fax (209) 937 -8893 <br /> v CD CCDZ <br /> 1TI INSPECTION APPLICATION 171 <br /> Application is hereby made for a In ur�ireed by t�Selmt;ton Municipal Code. 0 <br /> O <br /> n h, (D CL <br /> Application Date: I a I Q ht, Locallow City Q( Counly ❑ 'BUD O <br /> Cr . act C ! ' �rO tiNl (� — E [�YAeL�J Sj 0 ' 0 <br /> Describe Type of BusinessiServices : r-r, <br /> S �Au ) a - T1uS Business Owner 5 (p <br /> Name Nae m <br /> Suite D Me zip 9ys61 ,� <br /> BusinessAddress 1113 U � ' /' 1 Sb'�1.'��— t O <br /> Mailing AddressS4�i ,gi n Suite J NT!, zip Cl) <br /> Business Telephone �7 ` �4 / 2 - I y LiP Contact Person <br /> tN ' ) l Nay, ,JA- 0 O <br /> O <br /> E-Mail AddressO <br /> /► �avA. xQ �� �� ti Lei Uilc�r1l �4l g3 sl ,� � �'o S} reb .il sLiS �C <br /> Inspection Type 0 <br /> Check type of Inspection: , I _ D <br /> Special Inspection - City ( charge per hour) 'mcII Pte` tri <br /> ❑ Special Inspection - County Contract Areas (charge per hour) <br /> ❑ Permit and Code Compliance Inspection <br /> ❑ Permit and Code Compliance Inspection after 2n" Inspection (charge per hour) <br /> ❑ All other Field Inspections (charge per hour) ,t <br /> Describe purpose of Inspection : U S � K4E t° � _ 5 a� I <br /> Ate-' 'D, <br /> APPLICANT SIGNATURE _ \ DATE <br /> PRINT NAME: ftiI 1N&GIAL - <br /> ? o � 110 - 00 (0 <br /> BELOW FOR OFFICE USE ONLY <br /> Issued b : Date Issued: <br /> Check # -42— Vv— F� 7T P_ Ste- pC'J� <br /> Q.S(Secial Inspection - City: Pay Code XX $ ,�T <br /> ❑ 048-2631 -342 .23- 10 Special Inspection - County Contract Areas : Pay Code XX $ ) <br /> 048-2631 -342 .23-00 <br /> ❑ Permit and Code Compliance Inspection : Pay Code X-( $ 048-2631 -342 .23-00 <br /> ❑ Permit and Code Compliance Inspection after 20 Inspection: Pay Code XX $ <br /> ❑ All other Field Inspections : Pay Code XX $ <br /> 048-2631 -342. 23- 10 <br /> INSPECTION DATE/TIME : ' t �w1L \ \144 <br /> . _ . . nn n ✓Z� 7fW � c rNE�� cnl =21 _4+ <br /> INSPECTION RESULTS : � yL <br /> ., tia - fes_ <br /> -tea r r, c IZ . <br /> 11.1 Ulf I <br /> � ZJ <br /> ---- o m <br /> (n Q <br /> I � <br /> DATE _ =2,° 17 I C/) 0 <br /> C > � o <br /> INSPECTED BY : o <br /> While: FPD File yellow: Inspection Results to Customer Pink: Payment Copy to Cus ower <br /> m <br /> m 01117116 FPD FORM inspection Application <br /> 0) cri CrI <br /> (0 <br /> rn <br /> O <br /> N <br />