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Hug.uo-zu ub:bsa I norpe Home LUV40ZVbb1 p•7 <br /> -i <br /> Stockton Fire Department ® Fire Prevention Division <br /> 345 N. Et Dorado Street, Stockton,CA 95202 <br /> (209)937-8271 ® Fax(209) 937-8893 <br /> INSPECTION APPLICATION <br /> A plication=is hereby made for a Jnspectlon as requlred-by the Stockton Muff eJ Cade. <br /> • ® a • - - ao - of o- o <br /> Application Da ie: r� Location: City County❑. <br /> Describe Type of Business/Services:e _M_V45-&,i4ltJ <br /> Business Nam S Business Owner <br /> BusinessAddress Z <br /> S <br /> ell- 3O ..f�/fG��ie. dl= suite ziP ..zG ?. <br /> Mailing Addres <br /> Business Telephone Za `G ` . Contact Person <br /> E-Mail Address is X42 <br /> G E <br /> i.4)el 2,01 <br /> Check type of Inspection: <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 2na Inspection(charge per hour) <br /> '❑ All other Field Inspections (charge per hour) _ <br /> Describe pur se of Inspection: 2 l.-" F� CJ1l/ /2 � !/�+/ v��'•' <br /> �� . -71/J <br /> DATEAPPLICANT SIGNATURE <br /> PRINT NAME: i _ ._ �,< r rJi✓ •��/� <br /> l �6y' _ � iiax5J 06i zl <br /> BELOW FOR OFFICE USE.ONLY <br /> Issu y <br /> ed b : Date Issued: <br /> C <br /> Check# �=' ,,ll <br /> [ cial Inspection-City: Pay Code XX$ ��' V 048-2631-342.23-00 <br /> C]Special Inspection•County Contract Areas: Pay Code XX$100G.00 048-2631-342.23-10 <br /> ❑Permit and Cade Compliance Inspection: Pay Code XX$ 048-2631-342.23-00 <br /> E]Permit and Code Compliance Inspection after 2nd Inspection: Pay Code XX$ <br /> 048-2631-342.23-00 <br /> ❑All other Field Inspections' Pay Code XX$ 048-2631-342.23-10 <br /> INSPECTION DATE/TIME: — <br /> mmow-TIM4 RR1.q11tTS: <br />`r <br />'t <br />