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Republic ofthe Philippines Municipality of San Rafael Province of Bulaca UNIFIED APPLICATION FORM FOR BUILDING PERMIT Oo swee CO comptex Dew renew Dy pvenoxrony ‘THIS APPLIES ALSO FOR : [7] LOCATIONAL CLEARANCE TZ FIRE SAFETY EVALUATION CLEARANCE APPLICATION No. AREANO. 0X (OBE ACCOMPLISHED a By THE APPLICANT OWNER APPUCANT CST HOOE FASTA mW sonorrsirpsvsecnn FR CRSTRIRTON MES FER FONTS BYANENTENOR a a TOERTON OF CONSTRUGTIN. LOT NO _—— BRNO TEN RRND NO reer axRaNsa CAYIMMOPALTY OF SCOPE OF woRE Eprew cowsrsucron Crevovnoy ren, (Dlerection__ ] cowversion____ 7 accesssony BuILoINGiSTRUCTURE. CG aormon ______ [] repair 7 LeGaLizaTION oF EXISTING BUILDING. Coarreraon______ FJmovnc___ Covers (Spec). SE OF CHARACTER OF OCGUPANGT CDarour a: Resienma, 8) Ciarour e : commenciat etter rey aatalell Gi snes Linesvenmins ne Crom Aso Caceres | Epnexten oroatht coweran iu, Sree ET ome SBME moma Dou Donon BARON HOUSE tween.) " (Clsrour asseweuy (occuPanr ReiMlcnseenstoowmne time) Opa et savcamonacencmermea OROUE: NOM OUST. TM OME rou c:-covcarionaLerecremnous,. Ooi turgor musa Soran TS SERA Ce se ose QMICCENTER cnawsiat Domess—___ 1 geoupy 59) AGRICULTURAL Bases OSE: cteare aeourmosran — OSM tuna aa ee pera ee (Ci erouro sro OE eae Ss aa ee Dl HoserraL om Siar STRUCTURE | FacTOrY (FOR HAZARDOUS HIGHLY Cirour J: (-2) ACCESSORIES Fron ronrenes Pron Trac corer ete aot Botan cones SO Si cee as Bae ocean SacmTCASSTED SSR omne on BAG Tor TALE Wee FoR Etcracy SOF uN HED a tora Sh decmonc : - rmoroscoonccroosmucrey MM Sore orcoaienon = BOR ULL TE NSPECTOR AND SUPERVISOR OF CONSTRUCTION WORE REPRESENTING TE CHER es ARCHITECT OR CIVIL ENGINEER Lois rae (Signed and Seoled Ove Pind Name) Fine. ee Sens snts omer Teel TH TRF SOK PLT TY CONSENT LO OWNER AT WORE REPRESSTTATIE oe oo, Sean Oa TT Sa RT aes es ols Da Babi [Poa ened orion eoiaiet awit BK REPUBLIC OF THE PHILIPPNES: 1 ss CIVMUNGPALTYOR BEFORE ME, athe CayMunciay of on oho: — PUNT Ti aie Tae aROHTECT OR CL ENGNEER GortienesiON Dab Passa (nape ol So ne ena — re is TNSTARY PUBLIC Oesbw — See Copy Owner Copy: 080 ony 3 FP ‘Copy & Philippine Sass Autony “Nay equ stonalequrenens LNYOFTddW/4H3NMO 40 SAWN GFINIdd YAO SUNLYNOIS ‘sme| ajgeoudde Jougo pue Z}02 J0 oy foenud BIeQ BUR Jepun sjyBiy Au jo Kue eaten jou seop pue ‘eep euosied Jo Bulsseooud sry} Jo} Bua]H0 JeYjO Jo 20UsySIx9 ely apnjoaid Jou S20p jwasuco Aut yeu) pueysiepun | “e}ep jeuosied Aw jo Busseoqid ayy 0} ywasuon PUE sIUe}UOD S| pOoISIEPUN ‘wHO4 sity peed AneY | “Wel PASINER S11 PUE 9601 Gd JO Z0E uogoes 0} uensind sjueweunbay veyuewundop Jeyo a4) ym J84j=69) ‘sme {Uo}e|nBeu Jeuo|ssajo1d pue Sapod [eLlajad ‘eiqeaudde je pue yl pasiney si (960) Cd) seuIddiiyg etn Jo Bpog Buipyng jeucneN 84) 0} eoueY\duwod U| suEId B44 Jo sseuj2a1400 pue anisueyaidoo a4) Jo} agisuodseu aq |/2¥S O4M sjeuo!ssajoid uBIS@p BuipuodsaLioo ayy Aq pejeas pue auBis suojeayioeds pue sued ‘sued Kiossaooe pue Aejjoue eiqeaidde snoven aug Aq patuedwoode ‘leoulo Bulping 4) J0 20y)O pewiaduod e4y 0} paylwuans aq yeYS ‘pazuejOU AInp ‘wWiO4 uojeorddy Pequosaid paysydwoode Ayn a4, -Z yeaiaty pauinbas uojewuoyut/ ejep Azesseoeu og dn Buyy Aq ‘sysom uonoNs3sUOO ‘84 0 Josiwadnsyojsedsul aun in se Jey Aq pauoissluiWicd/pany eaUlGuR INQ OAYRNY ey) Jo/pUE S/euOISsajo1d UBisap pawseouod ay) Jo eoueysisse ay) YIM ‘wu UONeDIddy paquosaid aly YsicwioDde |jeySs ueaIddyEUM eu) “| *SNOILIGNOD CONV SWY3L qWwioL SYOMLOH 0 X¥LNOWONYISNOD 3009 auld 0 :ld48) ALFAVS Fld HOS SauTwNad 0 SB0uvHOUNS CO | YORAINI SOINOWLORTS 0 ONISWMd AXVLINYS. © TWoINvHOaN. Twos 0 TWwanonis Woo TWwanoauhowy ‘ONION C1 faearzabowan © | wo Oo Nog (ao) 3uNLONALS / ONITTIN HOF GN JO ONINOZ /TYNOLYOOT (YOLVALSININGY ONINOZ) ONINOZ HOS Ag aassassy ana ANAWSS3SSV LNNODov $334 G3ssassv ANNOWY 40 SiSva (WOISIAIG NOLLVITTVAa GN ONISS3OONd BHI AG G3HSMIANODOV 38 OL) 9 XOB

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