Form Center

2. Application for Fire Prevention Code Permit(s)

   Application is hereby made for Fire Prevention Code Permit(s) in accordance with the description for the purpose hereinafter set forth.  This application is made subject to all County and State laws and ordinances and which is hereby agreed to by the undersigned and which shall be deemed a condition entering into the execution of this/these permit(s).  

4. This application is for:

   1. Initial application for new permit(s)
   2. Renewal application for existing permit(s)
6. Permit Application for:
8. Business/Company Name
10. Physical Address for Permit
12. City
13. State
14. Zip Code
16. Business Mailing Address
18. City
19. State
20. Zip Code
22. Owner's Name
23. Phone Number
25. Owner's Address
27. City
28. State
29. Zip Code
33. Timeframe of Permit Request: Annual or Dates/Times
35. Emergency Contact Information:

    Emergency contacts should be available 24 hours a day, seven days a week for the duration of the permit period. Contacts should be able to respond to the permitted location within one hour after contact and be able to access all areas of the location. 

37. Primary Contact Name
38. Secondary Contact Name
40. Primary Contact's Phone Number
41. Secondary Contact's Phone Number
45. Permits may require additional application materials.

    Contact King George Fire, Rescue, and Emergency Services (540) 775-8900 for more information. 

    A permit, if granted, shall constitute permission to maintain, store or handle materials, or to conduct processes that produce conditions hazardous to life or property in accordance with the provisions of the County and State codes and ordinances.  Such permission shall not be construed as authority to violate, cancel or set aside any of the provisions of these codes.  Said permit shall remain in effect until revoked, or for such a period of time specified on the permit.  Permits are not transferable and any change in use, operation or tenancy shall require a new permit. 

    The fire official may revoke a permit or approval under the provisions of these codes if: 

    1. Right of entry to the premises and/or delivery vehicles for inspection at any reasonable time is denied to the fire official, or  
    2. Upon inspection, any violation of these codes exists or conditions of the permit have been violated, or  
    3. There has been any false statement or misrepresentation as to material fact in the application, data, or plans on which the permit or approval was based.
47. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
49. Electronic Signature

    I hereby certify that I read and examined this application and know the same to be true and correct.  I agree to all the conditions set forth in this application, and I give consent for any reasonable fire code inspections by the fire official.

    
    

50. Date
Leave This Blank:


54. 1. Receive an email copy of this form.
55. Email address

    This field is not part of the form submission.

56. Submit

* indicates a required field