HomeMy WebLinkAboutB1103-567 HKY FIRE RPT.PDFQaorFo',�
HICKORY FIRE DEPARTMENT
tRnknG*
Fire Prevention Bureau adY Phone: (828) 323-7522 Fax: (828) 323-7476 *Ko
� 5(�'I FIRE INSPECTION REPORT
C��1o3
Occupant P %�a S C o. C k� n� nl n Date 111,2103
Address f � Ll (a Mom► ry Phone No. -3 a R a y (o <o
Type of Occupancy F % Y Inspector Q2 % i c
Type of Inspection: 0 Initial Inspection Re -Inspection Other
Comments:
Inspection Status: Approved Temporary Approval _,Z� Disapproved
No. of Violations: Re -Inspection Date: Re -Inspection Fee: _
Name of Occupant: t/T/ ,%%z i) ,4'J Title
(Please Print)
Occupant Signature:
0N/1,4e 7,2
(Please Print)
Page of