FORM NO. BI 46 Rev. 8/19
Application for Elevator Permit
CITY OF VIRGINIA BEACH ∙ PERMITS AND INSPECTIONS
2875 Sabre Street, Suite 500 ∙ Virginia Beach, VA 23452 ∙ (757) 385-8065
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 #: _______________________
Agent for Owner (responsible for maintenance):
Agent Name: __________________________________________________________ None Designated
Street Address: _____________________________________________________________ Phone: _______________________
City: ________________________________________________________ State: _____________ Zip: ___________________
Email Address: _________________________________________________________ Cell Phone #: _______________________
Contractor:
Company Name: _____________________________________________ State Registration #: ____________________________
*Address: _______________________________________ *Phone: ______________________ *FAX: _____________________
Email Address: _________________________________________________________ Cell Phone #: _______________________
*Provide this information when registering company for the first time or if change of address, phone, fax, or email.
Equipment: New Replacement Modification Repair
Building Type: New Addition Existing Moved
Elevator/Lift Account Number: ______________
E
l
e
v
ator/Lift Type:
Dumbwaiter Manlift Stair Lift
Construction Lift Moving Walk Wheelchair Lift
Escalator Pool Chair Lift
Freight Elevator Passenger Elevator
Addit
ional Information:
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
Approved By: _________________________________________________________________________________ Date: ___________________
Applicant’s Name (Please Print): ________________________________________ Applicant’s 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.
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