REPUBLIC OF THE PHILIPPINES

OFFICE OF THE BUILDING OFFICIAL

PAGADIAN CITY
AREA CODE - 7322-V
APPLICATION NO. PERMIT NO.

DATE DATE

SANITARY / PLUMBING PERMIT

BOX 1 (TO BE ACCOMPLISHED BY SANITARY ENGINEER / MASTER PLUMBER IN PRINT)
OWNER LAST NAME FIRST NAME M.I. TAX IDENTITY NO.
PALOMARES JOE ANDROE A.
ADDRESS NO. STREET, BARANGAY, CITY / MUNICIPALITY TELEPHONE NO.

LOCATION OF CONSTRUCTION NO. STREET, BARANGAY, CITY / MUNICIPALITY

▫▫ ▫▫
SCOPE OF WORKS OTHERS (SPECIFY)

▫
ADDITION OF OF

▫
NEW INSTALLATION REPAIR OF OF
RENOVATION OF

▫▫ ▫▫
USE OR TYPE OF OCCUPANCY
RESIDENTIAL AGRICULTURAL

▫▫ ▫▫
COMMERCIAL PARKS, PLAZAS, MONUMENTS
INDUSTRIAL RECREATIONAL
INSTITUTIONAL OTHERS SPECIFY

FIXTURES TO BE INSTALLED
NEW NEW
QTY. EXISTING FIXTURES KIND OF FIXTURES QTY. EXISTING FIXTURES KIND OF FIXTURES
FIXTURES FIXTURES

▫▫ ▫▫ ▫▫ WATER CLOSET
▫▫ ▫▫ ▫▫ BIDETTE

▫▫ ▫▫ ▫▫ ▫▫ ▫▫ ▫▫
FLOOR DRAIN LAUNDRY TRAYS
LAVATORIES DENTAL CUSPIDOR

▫▫ ▫▫ ▫▫ ▫▫ ▫▫ ▫▫
KITCHEN SINK GAS HEATER
FAUCET ELECTRIC HEATER

▫▫ ▫▫ ▫▫ ▫▫ ▫▫ ▫▫
SHOWER HEAD WATER BOILER
WATER METER DRINKING FOUNTAIN SINK

▫▫ ▫▫ ▫▫ ▫▫ ▫▫ ▫▫
GREASE TRAP BAR SINK
BATH TUBS SODA FOUNTAIN SINK

▫▫ ▫▫ ▫▫ ▫▫ ▫▫ ▫▫
SLOP SINK LABORATORY SINK
URINAL STERILIZER

▫ ▫ ▫ ▫ ▫ ▫
AIR CONDITION UNIT SWIMMING POOL
WATER TANK, RESERVOIR OTHERS (SPECIFY)

▫ ▫ ▫
TOTAL TOTAL
WATER DISTRIBUTION SYSTEM SANITARY SEWER SYSTEM STORM DRAINAGE SYSTEM

▫▫ ▫▫ ▫▫
WATER SUPPLY SYSTEM OF DISPOSAL
SHALLOW WELL WASTE WATER TREATMENT PLANT SURFACE DRAINAGE

▫▫ ▫▫ ▫
DEEP WELL & PUMP SET SEPTIC VAULT / WHOFF TANK STREET CANAL
CITY / MUNICIPALITY WATER SYSTEM SANITARY SEWER CONNECTION WATER COURSE
OTHERS SU-SURFACE SAND FILTER
NO. OF STOREYS
PROPOSED DATE FOR THE
START OF INSTALLATION TOTAL AREA OF BUILDING SUBDIVISION SQ.M.
EXPECTED DATE
OF COMPLETION TOTAL COST OF INSTALLATION P
BOX 2 (TO BE ACCOMPLISHED BY THE BUILDING OFFICIAL)
ACTION TAKEN
PERMIT IS HEREBY GRANTED TO INSTALL THE SANITARY/PLUMBING FIXTURES ENUMERATED
HEREIN SUBJECT TO THE FOLLOWING CONDITIONS.
1 THAT THE PROPOSED INSTALLATION SHALL BE IN ACCORDANCE WITH THE APPROVED PLANS
FILED WITH THIS OFFICE AND IN CONFORMITY WITH THE NATIONAL BUILDING CODE.

2 THAT A DULY LICENSED SANITARY ENGINEER / MASTER PLUMBER BE ENGAGED TO

UNDERTAKE THE INSTALLATION / CONSTRUCTION. OIC-BUILDING OFFICIAL
3 THAT A CERTIFICATE OF COMPLETION DULY SIGNED BY SANITARY ENGINEER / MASTER
PLUMBER IN-CHARGED OF THE INSTALLATION SHALL BE SUBMITTED NOT LATER THAN DATE
SEVEN (7) DAYS AFTER COMPLETION OF THE INSTALLATION.

4 THAT A CERTIFICATE OF FINAL INSPECTION AND A CERTIFICATE OF OCCUPANCY BE

SECURED PRIOR TO THE ACTUAL OCCUPANCY OF THE BUILDING.
NOTE :
THIS PERMIT MAYBE CANCELLED OR REVOKED PURSUANT TO SECTION 305 & 306 OF THE "NATIONAL BUILDING CODE"
BOX 3 (TO BE ACCOMPLISHED BY THE RECEIVING & RECORDING SECTION)
BUILDING DOCEMENTS

▫ SANITARY PLUMBING PLANS & SPECIFICATIONS

▫ OTHERS (SPECIFY)

▫ BILL OF MATERIALS & COST ESTIMATES

BOX 4 ( TO BE ACCOMPLISHED BY THE DIVISION / SECTION CONCERNED)

ASSESSED FEES

PLUMBING PERMIT FEE AMOUNT DUE ASSESSED BY O.R. NO. DATE PAID

BOX 4 ( TO BE ACCOMPLISHED BY THE DIVISION / SECTION CONCERNED)

PROGRESS FLOW

NOTED : IN OUT
ACTION/REMARKS PROCESSED BY
CHIEF,PROCESSING DIVISION/SECTION TIME DATE TIME DATE

RECEIVING & RECORDING

GEODETIC (LINE and GRADE)

SANITARY / PLUMBING

WE HEREBY AFFIXED OUR HANDS SIGNIFYING OUR CONFORMITY TO THE INFORMATION HEREIN ABOVE SETFORTH

BOX 6 BOX 8

SANITARY ENGINEER/MASTER PLUMBER P.R.C. REG. NO. SIGNATURE

SIGN & SEALED & SPECIFICATION 0009772

PRINT NAME

FATIMAH AYNA M. LAO

ADDRESS APPLICANT

PAGADIAN CITY

P.T.R. NO. DATE ISSUED PLACE ISSUED COMMUNITY TAX CERT. DATE ISSUED PLACE ISSUED

3412322 JAN 4, 2021 PAGADIAN CITY

SIGNATURE TIN

322807906

BOX 7 BOX 9

SANITARY ENGINEER/MASTER PLUMBER P.R.C. REG. NO. TCT / OCT NO.

INCHARGED OF THE INSTALLATION 0009772

PRINT NAME PRINT NAME OF LOT OWNER

FATIMAH AYNA M. LAO

ADDRESS ADDRESS

PAGADIAN CITY

P.T.R. NO. DATE ISSUED PLACE ISSUED COMMUNITY TAX CERTIFICATE

3412322 JAN 4, 2021 PAGADIAN CITY

SIGNATURE TIN SIGNATURE

322807906