DEPARTMENT OF HEALTH AND HUMAN SERVICES
Licensure and Regulatory Services
255 Rockville Pike, Ste 100
Rockville, Maryland 20850-2368
240-777-3986 Fax 240-777-3088 www.montgomerycountymd.gov/licensure
TANNING FACILITY LICENSE APPLICATION Application is hereby made
for a license to operate a Tanning Facility in Montgomery County, Maryland
New
Renewal
TODAY’S DATE____________________
Name of Facility:: _________________________________________________________ Phone #:________________
(include area code)
Address of Facility:: ______________________________________________________________________________
Street Number and Street Name
_______________________________________________________________________________ City State Zip Code
Owner or Corporation Name:: _______________________________________________ Phone #:________________
Owner or Corporation Address ::______________________________________________________________________
Street Number and Street Name
Hours and Days Open for Business: ___________________________________________________________
Equipment Manufacturers Name, Type, and Year:_________________________________________________
Type Of Facility:
Nursery
Kindergarten
Elementary (state grades)____________
Secondary (state grades) _________
Post secondary (specify area of instruction)_____________
Accredited by State Department of Education?
Yes
No
Maximum number of students at any one time:_________ Number of students enrolled: _______
Do you intend to prepare/serve meals?
Yes
No (Bag and snacks are excluded from food service license)
Water supply: r Public
Private Sewerage:
Public
Private
Days and Hours of Operation: ______________________________________________________________
NEW FACILITIES OR CHANGE OF LOCATION FOR EXISTING FACILITIES:
Anticipated date of opening or change of location: ____________________________________________
Person to contact to arrange for an inspection:________________________________________________ Name Daytime Phone Number
Attach a copy of the Use and Occupancy permit for school use to this application. To obtain, call the Office of Use and Occupancy, 240-777-6240.
Attach a copy of the Fire inspection approval call 240-777-2457 to schedule for a fire inspection with the Fire Prevention Bureau/Fire Marshal office.
Fee Information: Please refer to Tanning Fact Sheet
Submit completed application and application fee to Licensure and Regulatory Services, 401 Hungerford Drive, 1st
Floor, Rockville, Maryland 20850. Payment must be made by check or money order, payable to “Montgomery
County, Maryland”. We are unable to accept cash payments.
