CITY OF PEORIA
											FIRE CODE COMPLIANCE PERMIT APPLICATION
									Tel 623 773 7279    
Fax 623 773 7295
											www.peoriaaz.gov/fire
																											
	
INSTRUCTIONS - READ ME FIRST

YOU CAN HELP US PROVIDE HELPFUL AND PROMPT SERVICE BY CAREFULLY COMPLETING ALL REQUESTED INFORMATION.  PLEASE PRINT OR TYPE LEGIBLY.  THIS IS A TWO-SIDED DOCUMENT.  FILL IN ALL PARTS AS NECESSARY.  IF STAFF HAS QUESTIONS YOU WILL BE CONTACTED.  YOUR APPLICATION MAY REQUIRE ADDITIONAL MATERIAL SUCH AS CITY BUSINESS TAX NUMBER, REGISTER OF CONTRACTOR LICENSE, ETC.  IN PARTICULAR, YOU MUST PROVIDE ACCURATE DETAILS AS TO YOUR COMPANY TYPE, RESPONSIBLE PERSON, AND ALSO THE IDENTITY OF AN AGENT FOR SERVICE OF PROCESS FOR LEGAL NOTICE.  PLEASE REMEMBER COMPLIANCE IS YOUR RESPONSIBILITY.  THANK YOU FOR YOUR COOPERATION.  	
																											
PART ONE

 
Company Information:
									[  ] Corporation   [  ] LLP
								 	[  ] Gen. Partnership
COMPANY NAME: 							[  ] LLC	[  ] Sole Proprietor

RESPONSIBLE PERSON: 											 (Title) 						

DAY-TIME TEL. (   ) 							 EMAIL: 											

MAILING ADDRESS: 																 ZIP 				

SITE ADDRESS: 																						

SITE RESPONSIBLE PERSON: 									 TEL. (   )					 

PART TWO

 - Agent for Service of Process:

Applicants must provide a valid name, street address, and day-time phone number for an “agent for service of process”.  This agent is applicant’s agent to receive service of process for legal notices and citations to ensure compliance with all applicable laws and regulations.  Changes in agent must be in writing and received by Fire Marshall to be valid.
	
SERVICE OF PROCESS AGENT: 																		

DAY-TIME TEL. (   )								 EMAIL: 											

STREET ADDRESS: 																	 ZIP 				
- Permits and Fees (Permits may be valid for one year):
PART THREE

Renewable Permits with Initial and Renewal Fees:

[ ]	Flammable Liquid Storage Tanks; Storage, Use, Handling, Dispensing - Install Fee - $360
	Renewal $250/Site

	[ ]	Hazardous Material, Use, Storage, Handling – Install/Change tanks or piping - $360.  Additional Tank - $50 ea. Modification - $100 ea. Renewal $150

	[ ]	Liquefied Petroleum Gas (LPG) Storage, Use, Handling, Dispensing - Install Fee - $360, Renewal $50

	Other Common Permits with Initial / Renewal Fee:


[ ] Auto Wrecking Yards $50

[ ] Blasting Ops. $100/$75

[ ] Carnival or Fair $200

[ ] Fireworks Display $500

[ ] Fire Protection Contractor $75

[ ] High Piled Storage $50

[ ] Hot Works $50

[ ] LPG Exchange Station $50

[ ] Lumberyard $50.00

[ ] Open Burn/Bon Fire $75
	
[ ] Places of Assembly $100/$150

[ ] Repair Garage $50

[ ] Spray Painting $50

[ ] Tent/Canopy $80

[ ] Motor Vehicle Fueling (portable tanks)  $50
[ ] Other: 					



Part Four
				
 - Applicant Date and Signature and Printed Name: 

Date:					Applicant Signature :(X)					
						
					PRINT NAME: 					

Part Five

 - Processing and Payment Instructions:


Apply in person at:
Development & Community Services Building  	       
9875 N. 85th Avenue		       
Peoria, AZ 85345




All required documentation MUST be present with completed application and payment for permit(s) to be processed.  Submit check or money order payable to “City of Peoria” for full amount.


Peoria Fire Permit App.doc (02/08)