Fillable FORM NO. BI 14 Rev. 08/19: Application for (City of Virginia Beach)

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FORM NO. BI 14 Rev. 08/19: Application for (City of Virginia Beach)

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File type: PDF

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FORM NO. BI 14 Rev. 08/19
Application for Utility/Right Of Way Permit
CITY OF VIRGINIA BEACH ∙ PERMITS AND INSPECTIONS
2875 Sabre Street, Suite 500 ∙ Virginia Beach, VA 23452 ∙ (757) 385-4558
FAX (757) 385-5777 ∙ www.vbgov.com/buildingpermits
Date: ___________________
A permit is hereby requested for the following construction at:
Street Address: _________________________________________________________ Lot #/Suite #: _______________________
Location with Nearest Cross Street: ____________________________________________________________________________
Owner/Occupant Name: ________________________________________________ Owner Phone: ________________________
Email Address: _________________________________________________________ Cell Phone: _________________________
Insurance Carrier Name (required): _________________________________________ Expiration Date: _______
______________
Address: _____________________________________________________________________ Phone: _____________________
Company Name: _____________________________________________ State Registration #: ____________________________
Address: _____________________________________________________________________ Phone: _____________________
Email Address: _________________________________________________________ Cell Phone: _________________________
Comments: __________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
I understand this permit is granted only for the work shown and described in this application.
Any falsification, misrepresentation, or misleading information given VOIDS this permit.
Applicant’s Name: ____________________________________________ Applicant’s Signature: _________________________________________________
Utility Project Number:
Plan Name:
Proposed Start Date:
Proposed Completion Date:
Emergency
Residential Commercial
Single Blanket
Public Private
DSC File Number:
CIP Number:
Bond Number:
Bond Amount: $
Cash Performance
QTY
FT
No. of Street Bores
Aerial
Anchors
Boring
Brick Mailbox
Cabinet
Cable
CBPA - Landscaping
CBPA – Tree Trimming
CIP Project
Conductor Box
Conduit
Crane
Culvert Pipe
Curb Numbering
Dig In Dirt
Driveway
Dumpster
E&S
Gas Line
QTY
FT
Hand Holds
Landscaping
Lashing
Lift
Locate Conduit Ends
Logging
Manhole
Open Cut Bike Path Length
Open Cut Bike Path Width
Open Cut Curb
Open Cut Driveway
Open Cut Median
Open Cut Sidewalk Joint
Open Cut Sidewalk Length
Open Cut Sidewalk Width
Open Cut Street Length
Open Cut Street Width
Open Cut Test Hole
Parking Pass
Pedestal
QTY
FT
Permanent Curb Cut
Pipe
Pole
ROW Curbing
Scaffolding
Site Development Plan
Small Cell Site - Existing
Small Cell Site - New
Splicing
Temporary Sign
Tracer Wire
Traffic Control Plan
Transformer
Tree Trimming
Trenching
Vault
VPDES
Window Cleaning
Wire
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FORM NO. BI 14 Rev. 0819: Application for (City of Virginia Beach)

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Completed 4 June 2021

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