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FAIRFAX COUNTY FIRE & RESCUE DEPARTMENT |
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Fire Marshal Use Only: |
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FIRE PREVENTION DIVISION |
Account Number: _________ |
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Revenue & Records Branch |
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Permit(s) Expire: _________ |
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10700 Page Avenue |
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Fairfax, Virginia 22030 |
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Phone: 703-246-4803 Fax: 703-246-4872 |
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APPLICATION FOR FIRE PREVENTION CODE PERMIT (FPCP)
Specific FPCP descriptions, fees, and types are outlined in the “FPCP and Filing Fee Requirements” guideline located at www.fairfaxcounty.gov/fr/prevention/. If you need assistance with this application, please call us at 703-246-4803.
Application for a Fire Prevention Code Permit (FPCP) is hereby made by the undersigned for the following process, installation, storage, occupancy or use:
FPCP DESCRIPTIONFPCP FEE FPCP TYPE
Open Flame & Candles: Public Meeting/Gatherings in A & E Use Groups (Each Event) $65F3FLM2
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*** APPROVEL OF OPEN-FLAME DEVICES REQUIRED ***
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IMPORTANT! - Submit a representative sample of each of type of open-flame decorative device requiring approval under this permit application.
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Photographs or drawing will not be accepted as substitute for a sample. Also provide manufactures' instructions, safety guidelines, device
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specification sheets, and Material Safety Data Sheets (MSDS) where provided.
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NOTE: Absent these documents, the Office of the Fire Marshal can only make a subjective evaluation on the safety and adequacy of a
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particular sample with respect to compliance with requirements of the Fire Prevention Code.
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RN WITH PAYMENT MAKE CHECK PAYABLE
Total Amount Due: $65
Return this application to the above address with payment. Make Check or Money Order Payable to “County of Fairfax”
Business / Headquarters: ________________________________________________________________________________________
Billing Address: ________________________________________________________________________________________________
Zip Code
I, __________________________________________ , hereby accept full responsibility for the adherence to all requirements of the
Printed Name
Virginia Statewide Fire Prevention Code (VSFPC) and the Fairfax County Fire Prevention Code pertaining to the above process, installation, storage, occupancy or use applied for in this permit application.
Permit / Inspection Location Name: ________________________________________________________________________________
Permit / Inspection Location: _____________________________________________________________________________________
Zip Code
Non-RUP or Zoning Permit # (Required for all Commercial Occupancies): ________________________________________________
Signature of Person Making Application: ___________________________________________________________________________
SignatureDate
Telephone: ____________________________________________ Emergency Telephone: __________________________________
FAX #:___________________________ EMAIL Address:_______________________________________________________________
NOTICE: ALL INFORMATION MUST BE PROVIDED BEFORE THIS APPLICATION WILL BE PROCESSEDN
FRD 69 (REV: 10/2008)
