Fire Department inspection report form

NYC 9/11 Public Portal Document

A*324R 86 9?1Z9g-8 11Q I FIRE DEPARTMENT, CITY OF NEW YORK • BUREAU OF FIRE PREVENTION

11 INSPECTION REPORT /I i

ACCOUNT ADM CO START DATE DO. TYPE

g'l/ir 1/1^1 OWNER NAME

Klak I l/lzb'lz^ 1 I I I I PREMISE ADDRESS

■DD INFO z? Ck/lx? ZlX la Lg iTREET NUMBER PREFIX - STRhfcT NAMF J.?/. c. A g Iaj ly. I BORO CODE • TYPE SUFFIX - ZIP CODE I 111 BILLING ADDRESS

kDD INFO JTREET NUMBER IK PREFIX - Ezm STHtfcT NAME EZLEnZ TYPE - SUFFIX ’ ZIP CODE BORO CODE •

ENTER HERE IF OUT OF TOWN

bdi STATE- ^1 I I J I 1 I ALPHA PREFIX 1 INSPECTOR NAME EXAMINER NAME DATE

CB ip-EM CODE I ITEM SUB-CODE | QTY I DESCRIPTION FLOOR NO

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COMMENTS

STATUS - CHECK AND COMPLETE INSPECTION DATE INSPECTOR - I D

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O VIOLATIONS REPORTED □ NOT APPROVED WITH REASON ENTER CODE | | | { 1 NEXT INSPECVON SCHEDULED: DATE

AKA ADDRESS

REET NUMBER PHtFtX >1 ] I REET NAME ’I I 1 I I SUFFIX [ ( I

znK ---------------Mre. AUDITOR. DATE.

NYC-WTC_000166087