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HICKORY FIRE DEPARTMENT
Fire Prevention Bureau
Phone: (828) - -7
FIRE INSPECTION REPORT
Occupant 1 Date
Address'' �' r fx Phone No.
Type of Occupancy w' Inspector,
Type of Inspection; /_,' Initial Inspection F Rc-inspection F—] Other
Comments:
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Inspection Status: Apprcivd Temporary Approval Disapproved
o. of Violations: Re -Inspection ate: Re -Inspection Fee:
Name of Occupant: a c" ri Title:
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Occupant Signature; , ki Page of