DEPARTMENT OF PERMITTING SERVICES
DIVISION OF FIRE PREVENTION AND CODE COMPLIANCE
Isiah Leggett Diane R. Schwartz Jones
County Executive Director
255 Rockville Pike, 2
nd
Floor, Rockville, Maryland 20850 | 240-777-0311
www.montgomerycountymd.gov/permittingservices
FIRE EXTINGUISHER LICENSE APPLICATION FOR PROFESSIONAL INDIVIDUALS
CHECK ONE: SUBMIT APPLICATION AND FEE TO:
[ ] New Application FIRE CODE COMPLIANCE SECTION
[ ] Renewal 255 Rockville Pike, 2nd floor
Rockville, MD. 20850
Total due with this application for above items: $55.00 (checks only, made payable to Montgomery County)
Perform Inspections, Maintenance & Testing
Applicant Name: Phone:
Address: Cell:
City/State/Zip: Fax:
E-mail:
YOU ARE REQUIRED TO NOTIFY THE FIRE CODE ENFORCEMENT SECTION OF ANY CHANGE OF ADDRESS
WITHIN 3 DAYS – FAILURE TO DO SO MAY RESULT IN SUSPENSION OR REVOCATION
Employer Name: Phone:
Address: Fax:
City/State/Zip:
I hereby agree that all servicing of portable fire extinguishers including: charging, filling, maintaining, recharging, refilling,
repairing, and testing which I do, will be done in compliance with the Montgomery County Fire Safety Code and the State
Fire Prevention Code, as to workmanship and quality of material used.
Signiture: ______________________________
FOR FIRE CODE ENFORCEMENT USE ONLY
Date Approved: Reason if Disapproved:
License Number: Renewal Date:
Authorized Signature:
Individual Will:
Effective: 7/1/08
