PERMIT APPLICATION
TO OPERATE
HOTEL-MOTEL
Date: ______________________
Business Trade Name: __________________________________________________________
Business Address: __________________________________________________________
__________________________________________________________
__________________________________________________________
Telephone Number: __________________________________________________________
Number of Rooms Available for Rent: _____________________________________________
Name of Applicant: __________________________________________________________
Address: __________________________________________________________
__________________________________________________________
Telephone Number: __________________________________________________________
Reset Form
This form may be printed blank or
filled in online and then printed.
Names and addresses of all persons listed as Owners, Trustees and officers of the corporations
and all persons in actual charge of the operations of the business. (Additional Sheets may be
attached).
Name: __________________________________________________________
Title: __________________________________________________________
Address: __________________________________________________________
__________________________________________________________
Telephone Number: __________________________________________________________
Name: __________________________________________________________
Title: __________________________________________________________
Address: __________________________________________________________
__________________________________________________________
Telephone Number: __________________________________________________________
List the name(s) and address (es) of any other Hotel or Motel owned, operated or managed by the
applicant, permitted, or any officer or trustee listed above.
Name: __________________________________________________________
Title: __________________________________________________________
Address: __________________________________________________________
__________________________________________________________
Telephone Number: __________________________________________________________
Name: __________________________________________________________
Title: __________________________________________________________
Address: __________________________________________________________
__________________________________________________________
Telephone Number: __________________________________________________________
Certification
I hereby certify the information contained herein is true and accurate to the best of my
knowledge:
Signed: ______________________________________________________
Date: ______________________________________________________
This application must be returned to:
Codes Compliance
2400 Washington Ave Newport
News, Virginia 23607 Phone:
757-926-8498
Fax: 757-926-8311
Email:codesclerical@nnva.gov
Cost: $100.00 per establishment
All information can be obtained online at:
www.nnva.gov/codes-compliance
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