GOVERNMENT OF THE UNITED STATES VIRGIN ISLANDS 
 
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DEPARTMENT OF PLANNING AND NATURAL RESOURCES 
Division of Coastal Zone Management 
 
No. 45 Estate Mars Hill, Frederiksted 
8100 Lindberg Bay, Ste #61, C.E.K. Airport 
St. Croix, US Virgin Islands 00840-4477 
St. Thomas, US Virgin Islands 00802 
Tel: (340) 773-1082; Fax: (340) 773-3343 
Tel: (340) 774-3320; Fax: (340) 714-9524 
 
 
REQUEST FOR REPAIR AND/OR MAINTENANCE WAIVER 
 
 
The following request is hereby submitted for a waiver of the permit requirement pursuant to 12 VIC § 
910(b)(1) of the VI Coastal Zone Management (CZM) Act. 
 
1. Name, mailing address, email address and telephone number of Applicant (all required)    
 
 
 
2.   Name, mailing address, email address and telephone number of the Property Owner (if not Applicant)  
 
 
 
3.   Location of activity. Plot No(s).   
 
 
  Estate    
 
   Island   
 
 
4.   Summary of proposed activity. Include the scope of all repairs to be undertaken such as roof, walls, decking,  etc.  
(Use additional sheets if necessary).   
 
 
 
 
5.   Please include the following required documents with your application: 
 
a)   Proof of legal interest (deed, tax bill, lease, etc.) 
b)   Required supporting schematics (drawings, photos, etc.) to be satisfied by Inspector’s    
request  
c)   Location Map 
 
In submitting such request I certify that the development activities are related to the 
repair/maintenance of an existing structure and will not result in an addition to, or 
enlargement or expansion, of the existing structure.  I agree to provide entry to the project site 
for inspectors from the environmental protection agencies for the purpose of making inspections regarding 
this request and that to the best of my knowledge and belief, that such information provided herein, is true, 
complete and accurate.  I further certify that I possess the authority to undertake the proposed activities.  
 
 
Signature of Applicant 
Date 
Signature of Owner 
Date 
 
 
Print   
 
Print   
 
 
SIGN
SIGN
 
FOR DEPARTMENT USE ONLY  
 
 
 
 
 
 
Your request for the waiver of the permit requirement has  
Inspector                   Date 
been deemed consistent / inconsistent with 12 VIC § 
910(b)(1) of the VI CZM Act.  
 
 
 
 
 
 
 
 
 
Commissioner 
 
Date 
 
SPECIAL CONDITIONS: