Fillable Applicant (Check One) Owner Contractor Agent Design Professional (City of Newport News)

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Applicant (Check One) Owner Contractor Agent Design Professional (City of Newport News)

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The Applicant (Check One) Owner Contractor Agent Design Professional (City of Newport News) form is 1 page long and contains:

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  • 16 check-boxes
  • 56 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of Newport News

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Date:
Application #:
ELECTRICAL PERMIT APPLICATION
Associated
Building Permit #:
Permit # EP
City of Newport News
Department of Codes Compliance
Permit Fee:
2400 Washington Avenue 3
rd
floor, Newport News, Virginia 23607
757-933-2311/757-926-8311 (fax)
www.nnva.gov/codes-compliance
Project Address:
Unit:
Parcel ID:
Applicant (Check One) Owner Contractor Agent Design Professional
Property Owner
Tenant
Applicant Name
Phone #
Name
Applicant Address
Address
Contractor Business Name
Phone #
City/State/Zip
Contractor Address
Phone #
Fax #
Contractor State License #
Class
A
B
C
CID #
Email Address
Email/Other Contact Information
Work to be performed on: Type of work: I agree to perform above work in compliance with the ordinances & regulations of the
City of Newport News and the Virginia Uniform Statewide Building Code.
Residential New Structure Repair/Alt
Print name_________________________________________Signature________________________________Date________________
Commercial Addition Other
Multi-Family Project Cost $___________________ Remarks_____________________________________________________________________________________________________
__________________________________________________________________________________________________________________________
QUANTITY & TYPE OF DEVICES/EQUIPMENT
New Outlets
Clothes Dryer
Range/Cooktop
Site Lights
Central Heat
Dishwasher (Domestic)
Oven
Reconnect Manufactured Home
Central A/C
Dishwasher (Commercial)
Exhaust Fan
New Single Phase Service
Amps
Heat Pump
Water Heater
Baseboard Heat
New Three Phase Service
Amps
Rooftop Unit
Garbage Disposal
Range Hood
Increase Service From
Amps to
Amps
Clothes Washer
Generator
Other
(Details)
__________________________________________________________________________________________________________________________________________________________________________________________
Office Use Only
Remarks:
Cash:
Check:
Escrow:
Customer ID #:
Approved By:
Date:
Cashier:
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Applicant (Check One) Owner Contractor Agent Design Professional (City of Newport News)

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Completed 24 January 2021

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