Republic of the Philippines

Quezon City
CITY PLANNING AND DEVELOPMENT OFFICE
ZONING ADMINISTRATION UNIT
4th floor, civic Center Bldg. D, Quezon City Hall Compound, Quezon City
Telephone: 988-4242 loc. 1014 & 1005
APPLICATION FOR LOCATIONAL CLEARANCE
FOR CONSTRUCTION
PLEASE FILL-UP COMPLETELY IN PRINT
A. BUSINESS NAME / TRADE NAME
SINGLE STOREY RESIDENCE
PROJECT ACTIVITY ü RESIDENTIAL COMMERCIAL INDUSTRIAL INSTITUTIONAL OTHERS

B. PROJECT OWNER / APPLICANT:

NAME: DE GUZMAN, ROWENA

ADDRESS: 38 CAPILLAN ST. BGY SAN ANTONIO, SFDM, QC.
AUTHORIZED REPRESENTATIVE ARSENIO DONA
CONTACT NUMBER: +63 919-421-1588
C. LOCATION:

1-B PASCUAL ST. NAGKAISANG NAYON NAGKAISANG NAYON 5

LOT NO. BLK. NO. NO. STREET SUBDIVISION BARANGAY DISTRICT

D. NATURE OF APPLICATION E. PROJECT TYPE

New Application New Application

Reconstruction Reconstruction

Others Addtional / Extension / Expansio

Others

F. PROJECT DESCRIPTION

No. of Units 1 H. Is there a pending criminal / administrative case and / or

complaint relative to the project activity? NO
No. of Storey / Floors 1
If yes, state the nature of case and / or complaint:
Lot Area

Total Floor Area of Building 46

G. RIGHT OVER LAND I HEREBY DECLARE UNDER THE PENALTIES OF PERJURY

THAT THE INFORMATION HAS BEEN FURNISHED IN GOOD FAITH,
Owner
VERIFIED BY ME AND TO THE BEST OF MY KNOWLEDGE AND
BELIEF IS TRUE AND CORRECT.
Lease

Others DE GUZMAN, ROWENA

SIGNATURE OF THE OWNER / APPLICANT OVER PRINTED NAME

INSTRUCTIONS / REMINDERS
I C - Z -
1. Application form must be duly ACCOMPLISHED and SIGNED by the
owner / authorized representative. Checked and
2. Keep a duplicate copy of the application form duly received by the Zoning
Received by:
Administration Unit (ZAU).
3. Present the documents together with your ID Card during transactions. Pay
application fees upon submission of the application form. Pay processing fee
before release of locational clearance. Submit a photocopy of the Official
Receipts. Date: DD/MM/YYYY
4. Only REGISTERED / RIGHTFUL OWNER or his DESIGNATED
REPRESENTATIVE with notarized authorization letter will be entertained.
5. FOLLOW-UP AND FIXING BY EMPLOYEES OF QUEZON CITY