FMD-F-11-02.49.

1
Control No.

PERMIT APPLICATION FORM

ESTATE: ____________________________________
DATE: ______________________________________

INSTRUCTIONS:

1. ACCOMPLISH THE FORM CORRECTLY

2. PRINT DATA LEGIBLY IN CAPITAL LETTER
3. SUBMIT THIS FORM TO THE EVALUATOR TOGETHER WITH THE REQUIRED SUPPORTING DOCUMENTS

PROPONENT/CONTRACTOR: ______________________________________________

COMPANY TIN: ______________

PURPOSE: ______________________________________________________________

CONTACT NO.: ______________

LOCATION: __________________________________________________________________________
PERIOD COVERED:

FROM:___________________________________

REPRESENTATIVE: _________________________________

TO: ____________________________________

DESIGNATION: _________________________________________________

PROJECT SUPERVISOR: _______________________________________________________

(TO BE FILLED BY APMC PERSONNEL)
REQUIRED SUPPORTING DOCUMENTS

TYPE OF PERMIT
NEW

MAINTENANCE
CONSTRUCTION
PASS-THRU
EVENT
MAINTENANCE
RENEWAL
CONSTRUCTION
PASS-THRU
EVENT
BOND
ROAD SIGNS
MARSHALS
OTHERS
TOTAL

OTHER REQUIREMENTS

RENEWAL

[ ]METHODOLOGY
[ ]GANTT CHART
[ ]LOCATION MAP

FEES
Php
Php
Php/50 linear meters
Php:
Php/truck/ mo.
Php:
To be assessed by TA/PM
Php:
To be assessed by TA/PM
Php:
Php
To be assessed by TA/PM
Php:
Php:

[ ]LAY-OUT
[ ]VISUAL PEG
[ ]JOB HAZARD ANALYSIS
[ ]ENDORSEMENT LETTER FROM
CLIENT/BUILDING ADMINISTRATOR
[ ]LIST OF TRUCKS (PLATE NO.AND MAKE)
[ ]OR/CR OF VEHICLE
[ ]PHOTOCOPY OF DRIVERS LICENSE
[ ]LIST OF MANPOWER
[ ]LIST OF TOOLS/EQUIPMENT

Php:

THIS IS TO CERTIFY THAT THE INFORMATION GIVEN IS TRUE AND CORRECT

_______________________________________
SIGNATURE OF REPRESENTATIVE

-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

FOR APMC PERSONNEL USE ONLY

TRANSMITTAL LOG
MESSENGER: _________________________________________________________________
TRANSMITTED TO: ____________________________________________________________
RELEASED BY: _______________________________________________________________
REMARKS (IF NOT RELEASED): ___________________________________________________

DATE/TIME: _____________________
DATE/TIME: _____________________

Commitment Date for Update: ___________________________

REVIEW AND APPROVAL LOG

1. COMPLETE APPLICATION FORM AND SUPPORTING
DOCUMENTS (PROPERTY MANAGER)
2. REVIEWED BY TECHNICAL ASSISTANT
3. APPROVED BY THE PROPERTY MANAGER
4. PAYMENT (ADMINISTRATIVE ASSISTANT/FINANCE
MANAGER)

SIGNATURE/DATE
_______________________

COMMENTS
________________________________________

_______________________
_______________________
_______________________

________________________________________
________________________________________
________________________________________

5. RELEASED

______________________

________________________________________

-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

PERMIT APPLICATION FORM

ACKNOWLEDGEMENT STUB

Control No.

NAME OF REPRESENTATIVE:
RECEIVED BY:
SIGNATURE OVER PRINTED NAME

DESIGNATION

NOTE: Verification of status may be made after ________working days upon receipt of application.

DATE