City of Port Phillip - City Permits

St Kilda Town Hall, Cnr Carlisle Street & Brighton Road

Phone: 9209 6216 Fax: 9536 2745
Email: devpermits@portphillip.vic.gov.au
Website: http://www.portphillip.vic.gov.au/permits_licenses_index.htm

ASSET PROTECTION APPLICATION

Community Amenity Local Law No. 3 Clause 20
PLEASE ALLOW AT LEAST 10 BUSINESS DAYS FOR THE ASSESSEMENT OF THIS APPLICATION
ASSET PROTECTION PERMIT MUST BE OBTAINED BEFORE COMMENCING ANY BUILDING WORKS
Property Details
Site Address:
Type of works to be undertaken:
(New dwelling, additions,
commercial development etc)
Expected Start Date:
Expected Completion Date:
Value of works:

In what capacity are you applying

for this permit?

Owner

Agent of Owner*

* Agent of the owner means the person authorised by an owner of a building or land
to make an application, appeal, referral or representation on the owners behalf.

Applicants Details
Applicant/Business Name:
Applicants Postal Address:

Telephone Number:
Facsimile Number:
Mobile Number:
E-mail Address:
A.B.N
A.C.N
Ownership Details (if different from the applicant)
Owners Name:
Owners Postal Address:

Telephone Number:
Facsimile Number:
Mobile Number:
Public Liability Insurance Details (Copy insurance policy document must be submitted with this application)
Insurer:
Policy No.:
Expiry Date:

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C:\Documents and Settings\lrowland\Desktop\Forms 12-13\Asset Protection Application.doc

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Bond Details
Single width dwelling lot with no other frontage or access:

$1,500.00

Double width dwelling lot that includes more than one street frontage, (corner site, laneway etc)
with or without gate access:

$2,500.00

More than one dwelling per lot, commercial development, or any other site conditions:

$ P.O.A

Note: Permit will not be issued until the application permit fees and bond are paid in full. The amount of the bond
may be increased where Council determines it is warranted.
Application Checklist
Copy of Public Liability Insurance
Payment of application fee ($196.00)

Refer to:
Fee Schedule

Payment Form for credit card payments

(cheques made payable to City of Port Phillip)

This Form Must Be Signed By the Applicant

I declare that I am an authorised person to apply for the Asset Protection and that all information in this application is
true and correct.
I accept and undertake to comply with the conditions specified on the permit and understand and accept that all fees are
non-refundable.
Applicants Name:
Date:

Applicants
Signature:

PRIVACY STATEMENT
The personal information requested on this form is being collected by the council for purposes of assessment in
accordance with Community Amenity Local Law No. 3, Clause 20. The personal information will be used solely by the
council for that primary purpose or directly related purposes.
The applicant understands that the personal information provided is for the purpose of considering the application for an
Asset Protection Permit and that he or she may apply to the council for access to the information. Requests for access
and or correction should be made to Freedom of Information & Privacy Officer Governance & Engagement Department,
City of Port Phillip.

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C:\Documents and Settings\lrowland\Desktop\Forms 12-13\Asset Protection Application.doc

Last Updated 21/06/2012