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2. Notice

   No permit will be issued until the $50 fee is received. Please make checks or money orders payable to "County of Henry" and send to:
   Henry County Fire Marshal's Office
   1024 DuPont Road
   Martinsville, Virginia 24112

4. Applicant Name*
6. Applicant Address*
8. City*
9. State/Province/Region*
11. Postal/Zip Code*
12. Country*
14. Applicant Phone Number*
16. Applicant Email*
18. Address of Blasting Site (If Applicable)
20. City
21. State/Province/Region
23. Postal/Zip Code
24. Country
26. Explosive Type*
28. Quantity*
30. Storage Address*
32. City*
33. State/Province/Region*
35. Postal/Zip Code*
36. Country*
38. Notes*

    List any additional information for the Fire Marshal.

40. Document Upload*
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42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit

* indicates a required field