HomeMy WebLinkAboutB4-574 HKY FIRE RPT 7-30-04.PDFV,gorsc�-
HICKORY FIRE DEPARTMENT
Fire Prevention Bureau
Ph (828) 323-7522 Fax.- (828) 323-7476 Hicho Y one.
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FIRE INSPECTION REPORT
Occupant 7- Date ill, 411V
Address d Phone No.
f ype of Occupancy Inspector
Type of Inspection: Initial Inspection EI Re -Inspection Other
Comments:
7
Inspection Status: Approved Temporary Approval Disapproved
No. of Violations: Re -inspection Date:--___ Re -inspection Fee®
Name of Occupant: Title- 5 "A
Pie se Print) (Please' Print)
Occupant Signature*