Republic of the Philippines Municipality of San Rafael Province of Bulacan OFFICE OF THE BUILDING OFFICIAL APPLICATION FOR BUILDING PERMIT new (Renewal [JAmendatory [APPLICATION NO, AREA No. i 0 Box 1 (Tobe accomplished in Pint by the apocan) covorressnoaouss on [BRR aE TREO FRSTORE Ti ia = [FOR CONSTRUCTION ORES FORIT OF GNERSTIE = Jovan enteRPRIse [AOGRESS. WORT ~~" SARANGAY —-CITVARONGPRITY EP CSOE——— TFET Ws |;ccarion GF GowsTaucTION oT No ——~Blewo Tern. TAXES WH, [sTREET_ BARANGAY CITY / MUNCIPALTY OF [SCOPE GF WORK = - Zz []rew constRuctiOn RENOVATION JRAsiING ERECTION |CONSERVASION | }scoessonvavaonrseTRUGTORE lAvomion JREPAIR [Jorsers (speci) JALTERATION Iuoving a USE OR CHARACTER OF OCCUPANCY JGROUP a: RESIDENTIAL Jorour F:inusreiaL [JoTHERs (spect) JGROUP 8: RESIDENTIAL. HOTEL, apaRrMen | ~|GROUP G: INDUSTRIAL STORAGE AND HAZAROO JGROUP C: EDUCATIONAL, RECREATIONAL [Jonoue i ecnenmIonn, Sehr OCCUPANT LOAD L886) |GRouP o: INSTITUTIONAL |GRouP : RECREATIONAL, ASSEMBLY OCCUPANT LOKD 1200 JoROUP €: BUSINESS AND MERCANTILE _[~]GROUP J. AGRICULTURAL, ACCESORY pura lOccUPANGY CLASSIFIED “oial Estimated cost P INUMBER OF UNITS e Proposed dso of Construction lrotaL FLOOR AREA Suumeniay Expected Date of Completion] 0x2 [FOLC Tie INSPECTOR ANG SUPERVISOR GF CONSTRUCTION WORT (REPRESENTING THE OWNER) Passe "ARCHITECT OR GWViL ENGINEER [PRO No ay (Signed and Sected over Printed name) [BTR No. baie issues ce tae re issued tri BOXS iS ‘BOK4 ae (APPLICANT: WITH MY CONSENT: LOT OWNER x Date: a Date: (Gignatire over Pitted Namo) ‘Gianature over Prniod Name) [Adarass: (Address: = [ere no. [Bais antes [Pisce issues [eTc no. [eats leaves [ace issues: BOXS: [REPUBLIC OF THE PHILIPPINES lorry / MUNICIPALITY OF 28) [BEFORE ME, atthe Ciyitiuricipally f +n personally appeared the folowing: APPLICANT TEN, Date eaied Place Tosued TGENSED ARCHITECT OR CIVIL ENGINEEE CEN, Bite sued Face sued (Punic apace Sige Creo wt) |Whose sinatures appear herein above, known tome tobe the same persons who executed thie standareprescrived form and package land acknowledged to me thatthe same I her fee and voluntary act and deed WITNESS MY HAND AND SEAL on the date and place above waite,13009 ONIGTINE WNOLLWN. 3H 4O ODE ONY $0e SNOLLOZS OL ANYNSUNd GBHOASY YO GSTISONVO SAV LMS SIML'3:ON 120 (eu pum ames) “JWiotdso onirine OULs¥o 30 OTIWHNO’ 2x8 Ganssl Lead verona a one ot as vrai vo pra eu ei Uo PE NRLBUN pecan a cD oH I Basing dL eh RLLNO ML ye voi fue 2 Roo Cup} aa sul ME ,HOPTURO BIN, pom peEunNZE AN e ATE eve mRRUAMO aL 1 (or wen sec taenucg eae suosvod a ase mceno pase pu peeved] Arp # fa AUP ea XS HOW a BEALE AA UHELOPUNS SURI Ba SUM sammonas ‘sopea uae osu nent: bysoe soxicaneeuunNeS soles ny sexueep vm Boe oy KSLA UP Nee OU We! ‘anor up amie 24 J Leper BO or oNseREURAN esd 0 LOUNEeo fowr=oORE i ane 2 ft ET99 pein ped senor p00 pene 9 ong ue fe SND pe eB AHO BupINa aN FOE Le NARABUNIG ORL ne Ajenee ee Supine 9g using C321 pe BuaiznepENEZE simsde pe sng one a fg0 ag ee oN SUR eo OHNYSMS Pe Nu PUNE AUB 942 I OL 09 uo easunsins pu a ue soe WED fue Sete a, DAUR FS SOLE pur SUHEDIPON ‘OVER es 0 ‘om us ace panes ind Lewpunue wader 9 pu RED ELAR PERN oR US LONE FuF uoNeADOW EBLE LEB vonsooads ues pane 1090 eon noo emnrasitupin ep eae 9 se nto a 0 vomuND jo HERD mE pueda FUE uBiO29 Ad PRS HPA ‘8 boo ae Gu pba Arp eGo Bub to ATE YE aU oN Eun em Sa YORI PHU UN “spo BuprienR a 122 w9HOg ch LENIN nes my EMD BUDE SNE -svsn 090 94 fa sumo pe a payee ep ea RE BUI Pence OC PLN Ao fu" VED EEK PTD HA BUEN \ejenasion ono up eso nn SEE UALS Ae 9 ont 8 eu ee ea do Hue AOUELG HERN SAO EAL "2 pada screed ag sno fata vearoped 2m min hon ced cep meas 0 Bp as wo Yon Ao wd Ye ves CL. 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