Forms


Most forms from the Department of Public Works and Environmental Services are available in PDF format. Some forms, as indicated, may be filled-out online prior to printing and/or must be submitted on legal size (8-1/2 inches x 14 inches) paper.

Forms can be accessed under the subject areas listed below or by searching with form name or keyword.

Search DPWES Forms

Building Permits & Inspections 

Fire Marshal Forms  

Form Name Fillable Legal Size
Building Information Form  
more...    

General Forms 

Form Name Fillable Legal Size
Request for Records (FOIA)    
Building Code Appeals Application  
Building Code Modification Request Form  
Home Improvement Contractor (HIC) Application  

Inspection Forms

Form Name Fillable Legal Size
Backflow Notice of Inspection | Device Testers  
Ejector/Grinder Pump Request Form  
Electrical Inspection Report and Certification Form  
Elevator/Escalator Certificate of Compliance    
Furniture Waiver Request  
Project Completion Checklist for Developer    
Request for Third Party Residential Inspections  
Sewer and/or Water Service Connection Agreement    
Statement of Special Inspection: PDF | DOC  
Swimming Pool Electrical Inspection Report and Certification  
Vent/Chimney Certification  

Permit Forms

Form Name Fillable Legal Size
Affidavit for Demolition of Accessory Structures  
Affidavit of Permit Authorization  
Amusement Device Application  
Annual Permit Application:  Commercial | Residential  
Annual Permit Report and Certification  
ANSI Square Footage Certification  
Asbestos Inspection Certification  
Asbestos Removal Certification  
Bond for Demolition of Building  
Cancellation / Refund Request  
Elevator Permit Application  
Elevator Supplemental Information for New Install  
Geothermal Certification  
Industrialized Building / Manufactured Home Affidavit  
Modified Processing Request Form    
Multiple-Family Residential Use Permit Application  
Owner / Developer Affidavit  
Permit Application | Instructions  
Property Ownership Affidavit  

Plan Review Forms

Form Name Fillable Legal Size
Accessibility Compliance Form  
Building Information Form  
Cover Sheet for Townhouses and Single Family Dwellings  
Electrical Energy Certification Form  
Expedited Building Plan Review Program Routing Form  
Permission to Edit Construction Documents    
Residential Heat Loss and Heat Gain Certification | Instructions  
Revision Routing Form    
Statement of Special Inspection: PDF | DOC  
Truss Plan Cover Sheet  
Waiver for Wall Mounted Signs  

Environment

General Forms

Form Name Fillable Legal Size
Solar Energy Equipment Tax Exemption: Form | Program Description  

Chesapeake Bay Preservation Ordinance Forms

Form Name Fillable Legal Size
Exception Request Form & Water Quality Impact Assessment-Minor Additions  
Exception for Public Hearing (RPA)  
Chesapeake Bay Preservation Ordinance Exemption/Exception Request

Stormwater Forms

Form Name Fillable Legal Size
Detention Pond Planting Application & Authorization Request Form  

Tree Conservation Forms

Form Name Fillable Legal Size
Celebrated Trees: Big Tree | Historic Tree | Commemorative Tree | Favorite Tree  
Tree Preservation Ordinance Request  
Request for Waiver/Modification of Tree Canopy and Transitional Screening/Barrier Requirements    

Land Use and Development

General Forms

Form Name Fillable Legal Size
Builder's Application for Temporary Waiver  
Buildable Lot Validation Request Form    
Class IVB Soils Certification  
Dustless Surface Maintenance Agreement
Geotechnical Final Report    
Hold Harmless Form #1
Hold Harmless Form #2
Land Disturbance Application  
Landscape Deferral Agreement | Instructions and Application  
Minor Site Plan Application Form
Modified Processing Request Form    
Parking Reduction Agreement    
Parking Tabulation Form    

Plan Coversheets:

   
Post Submission Conference Request Form  
Priority Rating Form for E&S Control  
Proposed Amendment to the Public Facilities Manual  
Record Plat and Final Subdivision Plat Checklist  
Request for Residential Use Permit  
Request for Waiver/Modification of the Provisions of Article 13 of Zoning Ordinance  
Request for Records (FOIA)  
Responsible Land Disturber Certification  
Simple Subdivision Eligibility Checklist  
Stormwater Management Plan Completeness Checklist  
Waiver/Modification/Exception Request Form  

Bonds and Agreements Forms

Form Name Original, double-sided print required Fillable Legal Size
Completion Agreement  
Conservation Agreement - Cash
Conservation Agreement - Letter of Credit
Development Agreement
Development Construction Schedule (sample only)      
Extension Request  
Future Construction Agreement  
Impervious Area Analysis    
Letter of Credit      
Letter of Credit - Conservation Agreement      
Letter of Credit - Extension Verification      
Letter of Credit - Extension Verification (Increase or Decrease in Bond)      
Letter of Credit - Tree Replacement Agreement      
Performance Bond (Corporate Surety)
Performance Bond - Verification Certificate      
Pro Rata Share Agreement
Sanitary Sewer Agreement  
Set-Aside Letter      
Set-Aside Letter - Bank Extension      
Site Inspection Fee Estimate Worksheet (.xlt)      
Stormwater Management Agreement
Street Inspection Guideline      
Surety Value Estimate (.xls)    
Tree Replacement Agreement    

Public Works and Utilities

Utilities Forms 

Form Name Fillable Legal Size
Streetlight Cost Estimate Request  

Wastewater Forms 

Form Name Fillable Legal Size
Business Film Developing Form  
Discharge Groundwater From Remediation Site    
Discharge Groundwater From Underground Storage Tank Remediation Site Form  
Discharge Landfill Gas Condensate From Nonhazardous Landfill  
Discharge Leachate From Nonhazardous Landfill  
Ejector/Grinder Pump Request Form  
Wastewater Discharge Application  
Sewerage Service Application  
Sewerage Service Application Fax Transmittal Form  
Zero Discharge Certification    

Recycling and Trash

See the list of Collection and Disposal Business Categories to determine which forms are relevant to your company.

(NOTE: All disposal forms require a W-9 "REQUEST for TAXPAYER IDENTIFICATION NUMBER and CERTIFICATION" be on file with the Fairfax County Solid Waste Management Program.  This form can be obtained from the IRS online or from their FAXBACK service at 703-368-9694, TTY 711. The form number is 10231 and the instruction sheet is form 20479.)

Collection & Recycling Forms 

Form Name Fillable Legal Size
Alternative Yard Waste Recycling System    
Waste Stream Calculation for Multifamily Properties  
Waste Stream Calculation for Nonresidential Uses  

Disposal Forms 

Form Name Fillable Legal Size
Application for Certificate to Operate, Collect, Transport and Dispose of MSW - Solid Waste Collector  
Application for Disposal Permit - Nonsolid Waste Collector    
Application for Tire Disposal Permit    
Application for Commercial Cash Permit  

Waste Delivery Disposal Agreement

   


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