Date:
Application #:
Associated
Building Permit #:
Permit # MP
Permit Fee:
FUEL GAS PERMIT APPLICATION
City of Newport News
Department of Codes Compliance
2400 Washington Avenue 3
rd
floor, Newport News, Virginia 23607
757-933-2311/757-926-8311 (fax) /codesclerical@nnva.gov
www.nnva.gov/codes-compliance
Project Address:
Unit:
Parcel ID:
Applicant (Check One) Owner Contractor Agent Design Professional
Property Owner
Tenant
Applicant Name
Phone #
Name
Applicant Address
Address
Contractor Business Name
Phone #
City/State/Zip
Contractor Address
Phone #
Fax #
Contractor State License #
Class
A
B
C
CID #
Email Address
Email/Other Contact Information
Work to be performed on: Type of work: I agree to perform the proposed work in conformance with the Virginia Uniform Statewide Building Code and the ordinances and
regulations of the City of Newport News.
Residential New Repair/Alt
Print name_________________________________________Signature________________________________Date________________
Commercial Addition Other
Multi-Family Project Cost $___________________ Remarks_____________________________________________________________________________________________________
__________________________________________________________________________________________________________________________
QUANTITY & TYPE OF DEVICES/EQUIPMENT
Type of Material
Outlets/Connections
Copper
Boiler
Range
CSST
Furnace
Oven
Steel
Rooftop Unit
Cooktop
Package Unit
Fryer
Type of Fuel Gas
Space Heater
Griddle
FUEL GAS STORAGE AND DISTRIBUTION
LP
Log Set
Other Cooking Appliance
Underground Piping to Building
Natural
Water Heater
Outdoor Outlets
Aboveground LP Tank
Manufacturer
Generator
Underground LP Tank
Capacity
_________________________________________________________________________________________________________________________________________________________________________________________
Office Use Only
Remarks:
Cash:
Check:
Escrow:
Customer ID #:
Approved By:
Date:
Cashier:
This application may be printed blank or filled in online and then printed.
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