Fillable FORM NO. BI 17 Rev. 8/19: Application for (City of Virginia Beach)

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FORM NO. BI 17 Rev. 8/19: Application for (City of Virginia Beach)

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FORM NO. BI 17 Rev. 8/19
Application for Gas Permit
CITY OF VIRGINIA BEACH ∙ PERMITS AND INSPECTIONS
2875 Sabre Street, Suite 500 ∙ Virginia Beach, VA 23452 ∙ (757) 385-8066
FAX (757) 385-5777 ∙ www.vbgov.com/buildingpermits
Date: ___________________ Associated Permit #: ______________________
A permit is hereby requested for the following construction at:
Street Address: _________________________________________________________ Lot #/Suite #: _______________________
GPIN: ____________________________________________________________________________________________________
Owner/Occupant Name: ________________________________________________ Owner Phone #: _______________________
Email Address: _________________________________________________________ Cell Phone #: _______________________
Contractor
Compan
y Name: _____________________________________________ State Registration #: ____________________________
Residential
Commercial
Additional Information:
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
Master Tradesman/Owner Name (Please Print): _________________________ Master Tradesman/Owner Signature: ______________________
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.
Plan Approval: ____________________________________________ FOG Permit: _________________________________________________
Contract Value: $
Building Type: New Addition Existing Moved
Release Required
Residential Commercial
Equipment: New Replacement Conversion Repair Relocation
Pressure Size: Low 2lb 5lb 11WC (Propane Only) Unknown
Gas Type: Natural Propane
* requires approved site plan
Outlet/Each
Outlet/Each
Gas Pack
Generator *
Infared Tube Heaters
Logs
Meter Change Out
Outdoor Grill
Oven
Pool Heater *
Outlet/Each
Propane Service Line
Range
Relocate Meter
Service Line
Shutoff Valve
Space Heater
Water Heater
Outlet/Each
Outlet/Each
Generator *
Grill
Humidifier
Industrial Equipment
Infared Tube Heater
Kiln
Logs
Medline (Surgical Vacuum)
Medline (Waste)
Meter Change Out
Meter Release
Outdoor Grill
Oven
Pool Heater *
Outlet/Each
Propane Service Line
Range
Relocate Meter
Rice Cooker
Roof Top Unit
Service Line
Shutoff Valve
Smokehouse
Space Heater
Steam Table
Water Heater
Wok
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FORM NO. BI 17 Rev. 819: Application for (City of Virginia Beach)

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Completed 4 June 2021

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