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F�Re Stockton Fire Department • Fire Prevention Division mm <br /> t " 345 N . EI Dorado Street, Stockton , CA 95202 <br /> ( 209) 937-8271 • Fax ( 209) 937- 8893 CITY OF <br /> STOCKTON <br /> ONE TIME FIRE PERMIT INSPECTION APPLICATION <br /> Application is hereby made for a per eventlone time fire permit as required by the Stockton Municipal Code. <br /> COMPLETEAPPLICANT • <br /> Application Date: 9/23/2022 Event Location : City County ❑ <br /> Describe Type of Event Removing two- 10 , 000 gasoline underground storage tanks <br /> Event Address 4501 N . Pershing Ave , , Stockton , CA Suite Zip 95207 <br /> Applicant or Business Name Innovative Construction Solutions <br /> IF APPLICABLE : Stockton Business License # Expiration Date <br /> Applicant's Address 2525 Stanwell Drive , Suite 200 , Conccord , CA Suite Zip 94520 <br /> Contact Person Howard Jones Contact Phone 714-715-7309 <br /> APPLICANTS - Place a check ✓ next to permit applied for: <br /> ✓ <br /> Type of Permit ✓ Type of Permit <br /> Fumigation and/or Thermal Insecticidal Fogging <br /> - <br /> Asbestos Removal- per event ONE TIME PERMIT State Law precludes the charging of a fee <br /> ONE TIME PERMIT - NO CHARGE <br /> ❑ Bowling Alley-pin/alley refinishing - Liquid/Gas Fueled Vehicles or Equipment in <br /> per event ONE TIME PERMIT Assembly Buildings, per event ONE TIME PERMIT <br /> ❑ Candles & Open Flames in Assembly Areas " <br /> per event ONETIME PERMIT Open Burning ONE TIME PERMIT <br /> Removal of Class I / Class II liquids from an <br /> El Carnivals & Fairs - per event ONE TIME PERMIT underground storage tank used for fueling motor <br /> vehicles ONE TIME PERMIT <br /> ❑ Christmas Trees when placed in public building ❑ Temporary Generator W/Flammable/Combustible Liquids Storage <br /> ONETIME PERMIT <br /> ALL APPLICANTS - READ AND SIGN - ALL INFORMATION IS SUBJECT TO VERIFICATION <br /> I have read this application and know the contents thereof and attest that the same is true and correct- <br /> I further acknowledge that the City of Stockton has adopted the Fire Code, and the amendments thereof, <br /> and use of the permit being applied for will conform to accepted standards. <br /> Alex Flink eOa911e: ly signed 022.0922YAex 16:5631ink <br /> 2 07'00' 9/22/2022 <br /> APPLICANT SIGNATURE DATE <br /> BELOW FOR OFFICE USE ONLY <br /> PERMIT FIRE PERMIT INSPECTION PERMIT TYPE FEE <br /> NUMBER one timepermit) <br /> SFD22-535644 REMOVE UNDGROUND FUEL TANKS $ 344 . 00 <br /> Issued by: ANDREA ARNEL Check # RECEIPT # 5115879 <br /> Pay Code : 5A $ CITY <br /> Date Issued : 9/28/2022 XX 048-2631 - 342.23-10 $ COUNTY <br /> INSPECTION RESULTS : <br /> INSPECTED BY : DATE <br /> 09/09/09 FPD FORM Permit Application White: FPD File Yellow: Inspection Results to Customer Pink: Payment Copy to Customer <br />