C/O
O City of Union C
City Fire Servicess 4009 Alvarado‐N
Niles Road, Union City, CA 94587
7 34
Phone: 510
0‐675‐5470 | Faxx: 510‐487‐2117
7 Fire Permit Application
n (Form FP‐0033) Officiall City Use Only
Customerr Account #: NOTE: P
Please complete
e and attach to yyour business liccense applicatioon if this is a new
w business requiring a fire perm
mit. INSTR
RUCTIONS: A Fire
e Permit is required to maintain,, use, store, or h
handle materialss, or to conduct pprocesses which
h produce condittions hazardous to life or property, or to install equipm
ment used in con
nnection with su
uch activities. If f your business inntends upon enggaging in any of the aforem
mentioned activvities, operationss, practices or fu
unctions, a Fire P
Permit may be reequired. Please identify all of yo
our intended acttivities by placing an “X” in the b
box provided. Iff you require asssistance, or would like more infoormation, contacct us at 510‐6755‐5470. APPLICA
ANT INFORMATIION 1.
D
Doing Business A
As (DBA) Name: 2.
B
Business Site Address (#, Street, Suite/Apt.): 3.
B
Business Site City, State, ZIP: 4.
B
Business Site Tellephone #: 6.
TTotal Project Squ
uare Fee: 8.
A
Application Grou
up: (mark appliccable permit typees): 5.
sq. ft. 7.
Annual or Special Event Assembly Businness Site Fax #:
Projeect Valuation ($)): $ Temporary U
Use Annual Operating / Storage 1.
C
Contractor Name
e: CONTRAC
CTOR INFORMATTION Compleete if new constrruction, remodelling, or retrofittinng will take placce on business siite: 2. Business Phonee: 3.
B
Business Addresss: 5.
C
Contractor Licen
nse #: 4..
City, State, ZZIP: 6.
Contact Phone:: Attach copies off the contractor’s license and ceertificate of insurrance if copies aare not on file wiith the City. 1.
P
Property Owner Name: 3.
O
Owner Address: PROPERTY O
OWNER INFORM
MATION Co
omplete if differeent from the bussiness owner: 2. Owner Phone: 4..
City, State, ZZIP: PERM
MIT(S) NEEDED
Referr to the permit liist and/or City’s Master Fee Scheedule to fill out tthe chart below:: Permit Description/T
Type/Scope Worrk PERMIT FFEE Plus (+) R
Range (if applicaable) x HOUR
RS (if applicable) TOTAL TTOTAL FEES DUEE NOTEE: Once issued, Permits must be p
posted at the job
b site, and shall not take the plaace of any licensee required by law
w. Permits are n
non‐
transfferrable. Upon a
acceptance of a P
Permit, the Perm
mittee agrees to comply with all Ordinance Proviisions now adop
pted or that mayy be adopted. I declarre under penaltyy of perjury, thatt to the best of m
my knowledge, all information coontained on thiss application is trrue and complette: Signatture of Applican
nt/Owner or Authorized Agent Printed Name an
P
nd Title Date Permit #: FIRE SERVICES REVIEEW (To be comp
pleted by City off Union City Firee Services Only) Feess Paid? Ye
es No D
Date: Union
n City Business LLicense Required
d? Fire Services Personn
nel Signature Reviseed 10/23/2012 Yes No Printed Name aand Title ‐ Page 1 ‐
Date Fire Perrmit Form FP‐003