FORM NO. BI 47 Rev. 8/19
Application for Amusement Permit
CITY OF VIRGINIA BEACH ꞏ PERMITS AND INSPECTIONS
2875 Sabre Street, Suite 500 ꞏ Virginia Beach, VA 23452 ꞏ (757) 385-4211
FAX (757) 385-5777 ꞏ www.vbgov.com/buildingpermits
Date
A permit is hereby requested for the following:
Street address:
Lot#/Suite#:
GPIN:
Owner/Occupant Name:
Owner Phone#:
E-mail Address:
If
unaddressed parcel, provide description to include nearest intersection:
Cell Phone#:
Insurance Carrier Name (required): Expiration Date:
Address:
Phone#:
Applicant Name: State Registration # (Class A, B, or C)
Address: Phone#:
Fax#:
E-
mail Address:
Cell Phone#:
Contract Value: $ Date Installed/Assembled: Removal Date:
Amusement Permit#: Special Events Permit#
Kiddie
Inflatables
Kiddie Mechanical
Major Rides
Spectacular Rides
Each
Annual Inspection
Specific Event
The following documentation must accompany each application:
Proof of Insurance
Complete and accurate ride listing specifying Manufacturer’s Information and Serial Numbers
Mechanical Rides—Manufacturer’s Non-Destructive Testing (NDT) requirements for all mechanical
rides – or — statement from Manufacturer that such testing is not recommended. (Ref ASTM F846-92
#8 and Virginia Amusement Device Regulation Part II Item E)
Additional Information:
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.
