Subject: Generic Permit Page 1 of 1
Date of revision: November 6, 2013
LOUDOUN COUNTY FIRE, RESCUE AND
EMERGENCY SERVICES
FIRE MARSHAL’S OFFICE
23675 Belmont Ridge Road, Suite 150
Ashburn, VA 20148
703-737-8600 703-737-8595 (fax)
www.loudoun.gov/firemarshal
APPLICATION FOR FIRE PREVENTION CODE PERMIT
GENERAL INSTRUCTIONS FOR THE APPLICANT
PLEASE PRINT OR TYPE ALL RESPONSES. FORM IS FILLABLE IN ACROBAT.
SUBMIT THIS APPLICATION TO THE FIRE MARSHAL’S OFFICE AT THE ADDRESS
LISTED ABOVE. PERMITS ARE NORMALLY PROCESSED WITHIN 10 BUSINESS DAYS.
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.
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, ____________________hereby 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.
Description Reference Existing Permit Number
Example:
Aerosol
2801.2
R050000000000
