Date:
Application #:
ELEVATOR PERMIT APPLICATION
Associated
Building Permit #:
Permit # EV
City of Newport News
Department of Codes Compliance
Permit Fee:
2400 Washington Avenue 3
rd
floor, Newport News, Virginia 23607
7
57-933-2311/757-926-8311 (fax) /codesclerical@nnva.gov (email)
www.nnva.gov/codes-compliance
Project Address:
Unit:
Parcel ID:
Applicant (Check One) Owner Contractor Agent Design Professional
Property Owner
Tenant
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 above work in compliance with the ordinances & regulations of the
City of Newport News and the Virginia Uniform Statewide Building Code.
Residential New Structure Repair/Alt
Print name_________________________________________Signature________________________________Date________________
Commercial Addition Other
Multi-Family Project Cost $___________________ Remarks_____________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________________________
QUANTITY & TYPE OF EQUIPMENT
Passenger Elevator
Powered By:
Machine Type:
Safety Type:
Inspection Type:
Other
Moving Walk
Electric Motor
Traction
Broken Rope
Hydraulic Jack
Freight Elevator
Hand Powered
Gearless Traction
Instantaneous
Pit
Wheel Chair Lift
Other
Drum
Gradual
Hoist way
Dumbwaiter
Screw
Type A with Oil Buffers
Machine Room
Stairway Lift
Hydraulic
Relief Valve
Rough In
Escalator Lift
Roped Hydraulic
Final
Material Lift
Rack & Pinion
Man Lift
__________________________________________________________________________________________________________________________________________________________________________________________
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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