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FIRE SAFETY INSPECTION REQUEST <br /> STD e~ =BEV .o-94~ See Instructions on reverse. <br /> AGENCY CCLTAC~S NAME TELEPHONE NUMBER REQUEST GATE PRO'RAM <br /> COMMUNITY ~ ~I~SING ' 6~ 26'-. ~ ~10/22J~1 C~109 <br /> <br /> 3 <br /> CODE8 <br /> <br /> LICENSING 1. ORIGINAL A, FIRECLEARA <br /> ~a~.c~ DEPARTMENT OF SOCIAL SERVICES <br /> .A~, A.~ COMMUNITY CARE LICENSING <br /> ADDRESS l CAPACI~ CHANGE <br /> 801 TRAEGER AVENUE SUITE 100 <br /> SAN BRUNO, CA 94066 <br /> 6, NAME CHANGE <br /> 7. O~ER <br /> AMBU~TORY MBU~TORY BEDRIDDEN TOTAL CA~AC~ <br /> <br /> SIL~I~r ~TTE C. I UCENSECA~G~y <br /> 1232 ~LL L~E <br /> <br /> ~DW~D CITYt ~ 94403 <br /> FACIU~ CONTACT PERSON'S NAME ~0~ <br /> ~ C. S[~[~ (650) 366-2786 ~'~RS <br /> <br /> TO BE COMPLETED By iNsPECTING AUTHoRiTY <br /> <br /> CLEARANCE GENIAL COCE <br /> <br /> R]~DWOOD CITY FIi~E DF. PT. <br /> ,. CODES <br /> AUTHORITY <br /> NAMEANO REDWOOD CITY, CA 94063 1._._FI__~ECLEARANCEORANTS~..~ <br /> AOOnESS 2~ F~RE CL~NCE DEN~ED <br /> A. EXITS <br /> -- i B. CONSTRUCTION <br /> <br /> C. FIRE ALARM <br /> INSP~R'S NAME ~Tym~orPrint~) TELEPHONE N~MBER -.-.. i CFIRS NUMBER <br /> ' -~ . j .... O. SPRINKLERs <br /> <br />E~IPLAIN DENIA!~O~ LIST SPECIAL CONI~TJ~I~i~ & [ ~' ~ / - <br /> <br /> <br />