Date:
Application #:
Associated
Building Permit #:
Permit # PL
Permit Fee:
PLUMBING 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 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
M
ulti-Family Project Cost $___________________ Remarks_____________________________________________________________________________________________________
__________________________________________________________________________________________________________________________
QUANTITY & TYPE OF FIXTURES
Water Closet
Clothes Washer
Water Service Line
Area Drain
Medical Gas Piping System
Other
Lavatory
Dishwasher (Domestic)
Sewer – Sanitary
Roof Drain
Drainage/Waste/Vent/Bldg
Shower
Dishwasher (Commercial)
Sewer Connection
Sewage Ejector/Pump
Water Distribution System
Bathtub
Drinking Fountain
Sewer – Storm
Other Appliance/Device
Manhole – Sanitary
Urinal
Other Fixture
Hub Drain
Grease Interceptor/GRD
Manhole – Storm
Sink
Water Heater (Electric)
Floor Drain
Oil Separator
Sewer Cap/Cleanout
Service Sink
Water Heater (Gas)
Floor Sink
Gas Piping System
Backflow Prevention Device
__________________________________________________________________________________________________________________________________________________________________________________________
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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