GOVERNMENT OF THE UNITED STATES VIRGIN ISLANDS DEPARTMENT OF PLANNING AND NATURAL RESOURCES DIVISION OF PERMITS STX DISTRICT TEL: (340) 773-1082 STT/STJ DISTRICT TEL: (340) 774-3320 PERMIT APPLICATION CONTROL FORM PROJECT INFORMATION APPLICANT NAME________________________________________________________ PHONE ___________________________________________________ NAME OF AUTHORIZED PERSON FOR PICKUP OF PERMIT _____________________________ PHONE__________________EMAIL ____________________ PROPERTY OWNER NAME __________________________________________________PHONE____________________________________________________ ADDRESS _________________________________________________________________ EMAIL____________________________________________________ PROJECT DESIGNER/ARCHITECT/ENGINEER____________________________________________________________________________________________ LICENSE NO. ______________________________________________________________ PHONE____________________________________________________ ADDRESS__________________________________________________________________EMAIL____________________________________________________ ELECTRICIAN_________________________LICENSE NO. ________________________ PHONE____________________________________________________ ADDRESS__________________________________________________________________EMAIL____________________________________________________ PLUMBER_____________________________LICENSE NO.________________________ PHONE____________________________________________________ ADDRESS__________________________________________________________________EMAIL____________________________________________________ PROJECT LOCATION/PLOT NO._________________________________ESTATE________________________________________________________________ QUARTER____________________________________________________ ISLAND________________________________________________________________ ZONING DISTRICT____________________________________________ PARCEL IDENTIFICATION NO.___________________________________________ PROJECT DESCRIPTION Description of land or water use intended, i e single-family dwelling, hotel, restaurant, etc. Provide details on all water and land development plans, including land preparation, site, and building construction, special construction, digging (including wells), water treatment, storage facilities, etc. REQUIREMENTS PRIMARY PERMIT: ☐ SUBDIVISION ☐ BUILDING PERMIT ☐ HISTORIC DISTRICT ☐ COASTAL ZONE MANAGEMENT SECONDARY APPROVAL REQ’D SUB’D DATE APPROVED BY DATE FEE PAID AIR POLLUTION CONTROL-CONSTRUCT/OPERATE ARMY CORPS OF ENGINEER BUILDING PERMIT CZM MAJOR LAND CZM MINOR LAND CZM MAJOR WATER CZM MINOR WATER DEMOLITION EARTH CHANGE ELECTRICAL PERMIT ENERGY COMPLIANCE FIRE SERVICE FLOOD HAZARD GROUP DWELLING HAZARDOUS MATERIAL REVIEW HISTORIC DISTRICT HOMEOWNER’S ASSOCIATION PLUMBING PERMIT PUBLIC WATER SUPPLY SYSTEM ROAD & DRIVEWAY STORMWATER SUBDIVISION PRELIMINARY SUBDIVISION FINAL UNDERGROUND STORAGE TANK SEWER CONNECTION/TREATMENT PLANT WATER DISCHARGE/POLLUTION CONTROL WATER QUALITY CERTIFICATION WELL DRILLING APPROPRIATION LEGAL DOCUMENTS REQUIRED: ☐CORPORATE AGREEMENTS ☐ LIST OF NEIGHBORING PROPERTIES ☐ DEED ☐ ZONING MAP ☐ P.W.D MAP ☐PROOF OF LEGAL INTEREST ☐ OTHER ________________________________________________________________________ DEPARTMENTAL USE ONLY RECEIVED BY: ______________________________________ DATE RECEIVED: _____________________________ REVIEWED BY: ____________________________________________________________________________________ ☐APPROVED ☐ DISAPPROVED DATE: _______________________________________ CONTROL NUMBER REMARKS: ________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ PERMIT NUMBER