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� HICKORY FIRE DEPARTMENT
Fire Prevention Bureau —0 ?�oZ
Phone: (828) 323-7522 Fax: (828) 323-7476 n I c I_ 0.11r
FIRE INSPECTION REPORT
Occupant X <J !E`" Date
Address Z/ l i 4� / !� ; % Phone No.
Type of Occupancy spe for
Type of Inspection: 2'Initial Inspection Re-Inspection11 Other
Comments:
z*
J
Inspection Status: Approved Temporary Approval
No. of Violations: ' Re -Inspection Date:
Name of Occupant:.
(Please rint)
Title:
Disapproved
Re -Inspection Fee:
(Please Print)
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