Republic of the Philippines

Quezon City
DEPARTMENT OF THE BUILDING OFFICIAL
APPLICATION FOR SIGN PERMIT

APPLICATION NO. DATE OF APPLICATION:

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

OWNER/APPLICANT LAST NAME FIRST NAME M.I.

FORM OF OWNERSHIP TELEPHONE NO.

ADDRESS NO. STREET BARANGAY CITY/MUNICIPALITY ZIP CODE

LOCATION OF INSTALLATION: LOT NO: BLK NO: TCT NO: TAX DEC. NO.:

STREET: BARANGAY QUEZON CITY

SCOPE OF WORK:
NEW SIGN RENEWAL: (Sign Permit No. __________________ Date Issued: _______________________ )
ERECTION CONVERSION RAISING
ADDITION REPAIR ANCILLARY BUILDING/STRUCTURE
ALTERATION MOVING OTHERS (Specify) __________________________________

USE OR CHARACTER OF SIGN

A. Type of Display 1. Single Face 3. Double Face 5. Multi-media
1. Neon 2. Illuminated 4. Painted-on 6. Other

B. Type of Installation
1. Business Sign, Wall Type 4. Business Sign, Tempoprary 7. Advertising Sign, Others
2. Business Sign, Projecting Type 5. Advertising Sign, Ground Type
3. Business Sign, Ground Type 6. Advertising Sign, Wall Type
C. Area / Dimension
L (m) = Wordings:
W (m) =
At (m2) =

BOX 2 (TO BE CHECKED, RECEIVED AND RECORDED)

ACCOMPANYING DOCUMENTS: FIVE (5) SETS EACH SIGNED AND SEALED BY RESPONSIBLE DESIGN PROFESSIONALS
CERTIFIED COPY OF TCT PHOTOCOPY OF LOT PLAN AND SITE DEVELOPMENT PLAN
IF NOT OWNED BY THE APPLICANT IN ADDITION TO THE PLANS OF SIGN STRUCTURES, STRUCTURAL DESIGN AND
CERTIFIED PHOTOCOPY OF CONTRACT OF LEASE COMPUTATION
PHOTOCOPY OF TAX DECLARATION AND LATEST REALTY SPECIFICATIONS AND COST ESTIMATES
TAX RECEIPT

BOX 3 BOX 4
DESIGN PROFESSIONAL, PLANS AND SPECIFICATIONS FULL-TIME INSPECTOR AND SUPERVISOR OF CONSTRUCTIN 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 5 BOX 6
BUILDING OWNER WITH CONSENT: LOT OWNER

(Signed Over Printed Name) (Signed Over Printed Name)

Date Date

BOX 7 BOX 8
CONTACT PERSON
CONTACT NO. AGE:

APPLICANT GENDER CIVIL STATUS

(Signed Over Printed Name) MALE FEMALE SINGLE WIDOW
Date
MARRIED OTHER