VIRGINIA C.

WITT REPAIR & RENOVATION OF VIRGINIA

SITIO AMERICA BONUAN BINLOC
DAGUPAN

PHRIXOS BUILDERS CORP

REGGIE B. MENDROS

VIRGINIA C. WITT VIRGINIA C. WITT

NBC FORM NO. B • 01
Republic of the Philippines
City of Dagupan
Province of Pangasinan
OFFICE OF THE BUILDING OFFICIAL
APPLICATION FOR BUILDING PERMIT
APPLICATION NO.
□ NEW □ RENEWAL □ AMENDATORY
AREA NO.

IIIIIIIIIII
BOX 1 (TO BE ACCOMPLISHED IN PRINT BY TliE APPLICANT)
11 I I I II I 11 I
OWNER/APPLICANT LAST NAME FIRST NAME M.I. TIN
DO NOT Fill• UP (NSO USE ONLY)
I
WITT VIRGINIA C.

I
FOR CONSTRUCTION OWNED FORM OF OWNERSHIP
BY AN ENTERPRISE

ADDRESS NO. STREET, BARANGAY, CITY/MUNICIPALITY ZIP CODE TELEPHONE NO.

I
SITIO AMERICA BRGY BONUAN BINLOC DAGUPAN CITY 2400 09999939208
LOCATION OF CONSTRUCTION LOT NO. -- BLK NO. --- TCTNO. TAX DEC. NO.
STREET SITIO AMERICA BARANGAY BONUAN CITY/MUNICIPALITY OF DAGUPAN CITY
SCOPE OF WORK
□
□
NEW CONSTRUCTION □X RENOVATION □ RAISING I
ERECTION □ CONVERSION □ ACCESSORY BUILDING/STRUCTURE ---
□ ADDITION □ REPAIR □ OTHERS (Specify)
□ ALTERATION □ MOVING

USE OR CHARACTER OF OCCUPANCY

□ GROUP A: RESIDENTIAL DWELLINGS
□ GROUP B: RESIDENTIAL HOTEL, APARTMENT
□ GROUP C: EDUCATIONAL RECREATIONAL
□ GROUP D: INSTITUTIONAL
□ GROUP E: BUSINESS AND MERCANTILE
□ GROUP F: INDUSTRIAL □ OTHERS (Specify)
□ GROUP G: INDUSTRIAL STORAGE AND HAZARDOUS
□ GROUP H: RECREATIONAL ASSEMBLY OCCUPANT LOAD LESS THAN 1000
□ GROUP I: RECREATIONAL ASSEMBLY OCCUPANT LOAD 1000 OR MORE
□ GROUP J: AGRICULTURAL ACCESSORY

OCCUPANCY CLASSIFIED TOTAL ESTIMATED COST P 3,156,958.56

NUMBER OF UNITS PROPOSED DATE OF CONSTRUCTION
TOTAL FLOOR AREA 236.60 SQUARE METERS EXPECTED DATE OF COMPLETION

BOX 2
FULL-TIME INSPECTOR AND SUPERVISOR OF CONSTRUCTION WORKS (REPRESENTING THE OWNER)

Address

PRC No. Validity

ARCHITECT OR CIVIL ENGINEER PTR No. Date Issued

(Signed and Sealed Over Printed Name)
Date Issued at TIN
BOX3 BOX4

APPLICANT: WITH MY CONSENT: LOT OWNER

VIRGINIA C. WITT Date VIRGINIA C. WITT Date

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

Address Address
CTC No. I Date Issued I Place Issued CTC No. I Date Issued I Place Issued
BOX 6
REPUBLIC OF THE PHILIPPINES )
CITY/MUNICIPALITY OF _____________� S.S.
BEFORE ME at the City/ Municipality of __________________ on _________ personally appeared
the following
VIRGINIA C. WITT
APPLICANT C.T.C. No. Date Issued Place Issued

LICENSED ARCHITECT OR CIVIL ENGINEER C.T.C. No. Date Issued Place Issued
(Full• ume Inspector and Supervlso1 ol COnstruclion Works)
whose signatures appear hereinabove, known to me to be the same persons who executed this standard prescribed form and acknowledg ed to me 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

NOTARY PUBLIC (Until December__ _�

Page No.====
Book No
Series of
 WITT VIRGINIA C.

SITIO AMERICA BRGY BONUAN BINLOC DAGUPAN CITY 2400 09999939208

SITIO AMERICA BONUAN BINLOC

VIRGINIA C. WITT VIRGINIA C. WITT

 WITT VIRGINIA C.

SITIO AMERICA BRGY BONUAN BINLOC DAGUPAN CITY 2400 09999939208

SITIO AMERICA BONUAN BINLOC

VIRGINIA C. WITT VIRGINIA C. WITT