Application for
L.P. Gas Plant Licence
Class of License:
 Class A
 Class B
 Class C
 Class D
Company/Business Name: ________________________________________________________________
Business Phone: _______________________________________________________________________
Business Address: _______________________________________________________________________
Business Contact Person: _________________________________________________________________
Business Email or Website:________________________________________________________________
Plant Name:___________________________________________________________________________
Physical Plant StreetAddress: ______________________________________________________________
License fee is $225.00 for 3 years. All licenses expire on December 31, 2018.
Please make cheque payable to the Minister of Finance.
Qualified Personnel (located at refill centers only)
Name of Person
Name of License
I hereby certify that to the best of my knowledge and ability the information that I have provided on
this form is true and complete.
Applicant Signature ____________________________________
Date: _______________________
Please Note: Personal information on this form is collected under section 31 (c) of the Freedom of Information and Protection of
Privacy Act R.S.P.E.I. 1988, c. F-15.01 as it relates directly to and is necessary for the administration of the Propane, Natural and
Manufactured Gas Program. If you have any questions about this collection of personal information, you may contact the Chief
Boiler Inspector, Department of Communities, Land and Environment, 31 Gordon Drive, Charlottetown, PE, Canada P.O. Box
2000 C1A-7N8, Tel: (902) 368-5280.
License Class: _________________________
Fee: ____________________________
Initials: ___________________________
Entered:Yes________No______________
Receipt No.: ________________________
15EN15-42260