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HICKORY FIRE DEPARTMENT / `Q,�PROrECroy Fire Prevention Bureau
Phone: (828) 323-7522 Fax: (828) 323-7476 tllcno r
FIRE INSPECTION REPORT
Occupant l} Date
Address Phone No.
Type of Occupancy A Inspector
Type of Inspection: ❑ Initial Inspection Re -Inspection Other
Comments: 6/(�
Inspection Status: Approved Temporary Approval
No. of Violations:
Name of Occupant:
Re -Inspection Date:
(Please Print)
Title:
c4?x3-/30c
Disapproved
Re -Inspection Fee:
(Please Print)