REPUBLIC OF THE PHILIPPINES

QUEZON CITY
DEPARTMENT OF THE BUILDING OFFICIAL
APPLICATION FOR BUILDING PERMIT
NEW RENEWAL AMENDATORY
APPLICATION NO.
DATE OF APPLICATION:

BOX 1 (TO BE ACCOMPLISHED IN PRINT BY THE OWNER/APPLICANT)

OWNER/APPLICANT LAST NAME FIRST NAME M.I. TIN

FOR CONSTRUCTION OWNED BY FORM OF OWNERSHIP

AN ENTERPRISE
ADDRESS NO. STREET, BARANGAY, CITY/MUNICIPALITY ZIP CODE TEL. NO.

LOCATION OF CONSTRUCTION: LOT NO.: ____ BLK NO.: ___ _ TCT NO.: ___ TAX DEC. NO.: ___ _

STREET: ___ BARANGAY: ___ _, QUEZON CITY

SCOPE OF WORK:
RENOVATION RAISING
NEW CONSTRUCTION
ERECTION CONVERSION ACCESORY BUILDINGS/STRUCTURE
ADDITION REPAIR OTHERS (Specify)
ALTERATION MOVING
USE OR CHARACTER OF OCCUPANCY

GROUP A: RESIDENTIAL, DWELLINGS GROUP F: INDUSTRIAL OTHERS (Specify)

GROUP B: RESIDENTIAL, HOTEL, APARTMENT GROUP G: INDUSTRIAL STORAGE AND HAZARDOUS
GROUP C: EDUCATIONAL, RECREATIONAL GROUP H: RECREATIONAL, ASSEMBLY OCCUPANT LOAD LESS THAN 1000
GROUP D: INSTITUTIONAL GROUP I: RECREATIONAL, ASSEMBLY OCCUPANT LOAD 1000 OR MORE
GROUP E: BUSINESS AND MERCANTILE GROUP J: AGRICULTURAL, ACCESORY

OCCUPANCY CLASSIFIED TOTAL ESTIMATED COST P

NUMBER OF UNITS PROPOSED DATE OF CONSTRUCTION

TOTAL FLOOR AREA SQUARE METERS EXP[ECTED DATE OF COMPLETION

BOX 2 BOX 3
DESIGN PROFESSIONAL, PLANS AND SPECIFICATIONS FULL-TIME INSPECTOR AND SUPERVISOR OF CONSTRUCTIVE WORKS

ARCHITECT OR CIVIL ENGINEER ARCHITECT OR CIVIL ENGINEER

(Signed and Sealed Over Printed Name (Signed and Sealed Over Printed Name
Date Date

Address Address

PRC No. Validity PRC No. Validity

PTR No. Date Issued PTR No. Date Issued

Issued at TIN Issued at TIN

BOX 4 BOX 5
APPLICANT: WITH MY CONSENT: LOT OWNER

(Signature Over Printed Name) (Signature Over Printed Name)

Date Date

Address Address

CTC No. Date Issued Place Issued CTC No. Date Issued Place Issued

) S. S.
BOX 6

REPUBLIC OF THE PHILIPPINES

CITY/MUNICIPALITY OF ____ _ _ _ _

BEFORE ME, at the City/Municipality of ______ _ _ _ _ _ _ _ _ _ , on _____ _ _ _ personally appeared

the following:

__ _ _ _ _ _ _ _ __ _ _ __ _ _ __ _ _
APPLICANT C.T.C. No. Date Issued Place Issued

__ _ _ _ _ _ _ _ __ _ _ __ _ _ __ _ _
LICENSED ARCHITECT OR CIVIL ENGINEER C.T.C. No. Date Issued Place Issued
(Full-Time Inspector and Supervisor of Construction Work)

whose signatures appear hereinabove, known to me to be the same persons who executed this standard prescribed form and ackno wledged to that the same is their free and voluntary
act and deed.
WITNESS MY HAND AND SEAL on the date and place above written.
Doc. No. ____
Page. No. ____ __ _ _ _ _ _ _ _ _ _ _
Book. No. ___ _ NOTARY PUBLIC (Until December ____ _ )
Series. of. ___ _

QCG-DBO-CPA01-V01