ANNE ARUNDEL COUNTY
DEPARTMENT OF INSPECTIONS & PERMITS
License Section—MS 6006
2664 Riva Road ● Annapolis, MD 21401 PH 410-222-7788
MDL_____________
Initial Transfer Renewal
Date _________________________________________
APPLICATION FOR OPERATING LICENSE FOR MULTIPLE DWELLING OR ROOMING HOUSE
Return this form with your check payable to Anne Arundel County
Name of Facility____________________________________ Address of Facility_______________________________
Tax Account # ____________________________________________ Zip Code_____________ # of Stories _______
Elevators? Yes/No # of Structures _______ Building Permit # __________________ or Existing Building Yes/No
Type of Heat ____________________________ Air Conditioning ___________________________________________
Water Supply: Private Public Sewage Disposal: Private Public Registered with MDE Lead Program? Yes/No
Specify the nature and number of units in this facility
Apartment : Total # ______Units: Efficiency_____ ,1 Bedroom ______ , 2 Bedroom ______ , 3 Bedroom______
4 Bedroom or more ______ , # Vacant Units ______ # Households on waiting list ______
# Age Restricted Units ______ # Fair Housing Act (FHA)/ADA Units _______
No utilities included in rent.
Utilities included in rent: Gas Electric Water Sewer Trash Recycling Heat Cable TV Internet
Accept tenant based housing vouchers or subsidies Have project based voucher units Income restricted units
Community financed with other federal/state subsidy programs:_________________________________________
Public spaces accessible to individuals with disabilities Wheel chair accessible route throughout the community.
Federal Fair Housing (FHA) & Americans Disabilities Act (ADA)? Very Familiar Somewhat Familiar
Not Familiar
Motel or Hotel : Total # of Rooms ________ Dormitory: # of Rooms _________ # of Beds______________
Bed & Breakfast Establishment or Rooming House: # of guest rooms ________
Name of Owner:______________________________________________ Telephone: __________________________
Owner’s Address: ______________________________________________________ Zip Code: _________________
All correspondence should be directed to: __________________________________ Phone: __________________
Address: _____________________________________________________________ Zip Code:_________________
If transfer of ownership, state name of previous owner ____________________________________________________
The applicant hereby certifies and agrees as follows: (1) that he is the owner of, or the duly authorized Agent of the own-
er of the facility on this application; (2) that he has read all of the information above set forth and that the same is correct;
(3) that the license, if issued, may be declared void should said information be incorrect; (4) that he will comply with all
rules and regulations of all Departments of Anne Arundel County which are applicable hereto; (5) that owner grants to
Anne Arundel County a right of entry to the property for the purpose of inspecting for compliance with Anne Arundel
County law. Denial of entry for inspection may result in revocation of this license; (6) that he will notify the Department
within 7 days if there is a change of ownership or in the Agent(s) who are listed above; (7) such notice shall include the
name and address of the person or persons succeeding in the ownership or control of such multiple dwelling or room
house.
Signature _________________________________ Printed Name__________________________________________
If owner is not a resident of Anne Arundel County, list his Agent and an alternate Agent, (a non–resident applicant may
be one of the two) for the receipt of notices of violation of the provisions of the Construction and Property Maintenance
Code and for services of process pursuant to the Code. Signatures of all such Agents must be acknowledged before a
Notary Public. The applicant may designate any person, residing in Anne Arundel County, as his Agent or alternate
Agent for this purpose. By completing the Agent and Alternate agent section of this application, the applicant is
authorizing each agent so designated to act on his behalf. Provide the agent information on separate attachments to this
application.
DO NOT WRITE BELOW THIS LINE
Approved:
# Units__________________ Health___________________ Fire Marshal________________ Zoning
___________________
Revosed 2/2/18
