FORM NO. BI 72 REV. 08/19
Application for Residential New/Addition/Alteration Permit
CITY OF VIRGINIA BEACH ∙ PERMITS AND INSPECTIONS
2875 Sabre Street, Suite 500 ∙ Virginia Beach, VA 23452 ∙ (757) 385-8060
FAX (757) 385-5777 ∙ www.vbgov.com/buildingpermits
Date
A permit is hereby requested for the following construction at:
Street Address: Lot #/Suite #:
GPIN:
Owner/Occupant Name: Owner Phone #:
Email Address: Cell Phone #:
Mechanic’s Lien Agent Name: None Designated
Address: Phone #:
Email Address: Cell Phone #:
Contractor:
Company Name: State Registration #:
Check Scope of Work: New Addition Alteration
Total cost of construction/alteration: $
# of Bedrooms # of Bathrooms
Public Utilities Receipt #: __ __ HRSD Receipt #: ____ EIFS (Yes/No): __________
For New Structures Total the Sq. Footage: _______________
Ad
ditional 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.
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