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 
    APPLICATION for BUILDING PERMIT 
 Applied for Under: The USVI Building Codes 
 (Please Print Clearly) 
Parcel Identification Number (PIN) ___________________________________________________ 
Owner of building:  ________________________________________________________________  
      
Owner mailing address: _____________________________________________________________ 
Lessee information: ________________________________________________________________ 
  
Plot No. __________   Estate ______________________ Quarter _____________ Zone _______ 
                      
House No. ________ Street ________________________   Flood Zone ____________________  
              
  (If Applicable) 
General statement of the proposed work: 
___________________________________________________________________________________________________________________ 
________________________________________________________________________________________________________ 
________________________________________________________________________________________________________ 
Description of the proposed work and information related thereto: 
1.
Occupancy: No. of Units:  _____________ No. of stories: ______________
2.
Floor area: __________________ sq. ft. (exterior dimension)    Total Structure _______________________ sq. ft.
3.
Type of exterior walls: __________________
 Building Height ___________________________          
4.
Type of roof: __________________________
5.
Roof area used for catchment: ____________
6.
Cistern    ☐ New   ☐ Exists
7.
Cistern interior dimensions: _____ft. long x _____ft. wide x ______ft. (high to overflow) x 7.5 ____ gallons.
8.
No. of bedrooms: ______________________
9.
No. of bathrooms:  _____________________
10. Total no. of other rooms: ________________
11. No. of plumbing fixtures: ________________
12. Total no. of rooms with electrical service _________________________________________________________
Will proposed work encroach on public rights-of-way or on the property of others ____________________________
Total estimated cost of the proposed work: $ ___________________      
 Has work been started? ______________ 
The contractor who will perform the work. _____________________        License No.  _______________________ 
Signature of owner: _______________________________________           Date signed: _______________________ 
    Phone No.: ________________________ 
DEPARTMENTAL USE ONLY 
Information requested. Remarks: _______________________________________________________________________________________ 
Estimated Construction Cost: ____________________________________________ (Government estimation for solely permit purposes). 
☐Permit approved  ☐ Permit disapproved
  _________________________________
    Commissioner or Designee, DPNR    
________________________________ 
   Permit No. 
 ________________________________
     Fee     
Class of Work 
☐New
☐Alteration
☐Addition
☐Repair
Use of Building 
☐Residential  ☐Commercial
Group Occupancy 
Classification: ____________ 
☐Other _________________
BP Fees 
Prepaid Amount 
Fee Balance 
Location of Work