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LOUDOUN COUNTY FIRE- RESCUE AND EMERGENCY MANAGEMENT OFFICE OF THE FIRE MARSHAL 803 Sycolin Road, #104 (MSC 61A) Leesburg, Virginia 20175 (703) 737-8600 (703) 737-8595 (fax) APPLICATION FOR FIRE PREVENTION CODE PERMIT Application is hereby made by the undersigned for a Fire Prevention Code Permit to conduct the following industry, trade, occupation, storage or use: When applying for a Fire Prevention Code Permit, use the following example to complete the section, description and reference provided in the fee schedule. The fee schedule is available at www.loudoun.gov/fire/marshal, or contact the office and one will be mailed to you. Description Reference Existing Permit Number Example: Aerosol 2801.2 R050000000000 1. 2. 3. 4. 5. Amount Due: $ Business Name: Billing Address: Street Address City State Zip Inspection Property Address: Street Address City State Zip Inspection Property Address cont’d: ADC Map Page ADC Grid TaxMap/PIN: Explosive Transport Vehicle: VIN Make Number State Tag Name of person making application: Print full name Telephone: Emergency Telephone: I, accept full responsibility for the adherence to all requirements of the Virginia Statewide Fire Prevention Code and the Loudoun County Fire Prevention Code pertaining to the above application. Please return this application with check or money order payable to the County of Loudoun.