Republic of the Philippines Province of Bulacan Office of the Building Official San Rafael, Bulacan Application No. Date of Application Date Issued FENCING PERMIT Box 1 (To be accomplished by the applicant in print NAME OF APPLICANT: LAST NAME FIRST NAME MI TAX NO. FOR CONSTRUCTION OWNED FORM OF OWNERSHIP BY AN ENTERPRISE ADDRESS: No. Street Barangay City/Municipality Location of Area No. Street Barangay City/Municipality To be Fenced SCOPE OF WORK: Addition Renovation New Fence Repair Others (Specify) Box 2 (To be accomplished by the Receiving and Recording Section) ACCOMPANYING DOCUMENTS: Xerox Copy of T.C.T. Xerox Copy of LovSite Plan Xerox Copy of Latest Land Tax Receipt Xerox Copy Contract of Lease (If not owned by applicant) Other clearance (Specify) Box 3 (To be accomplished by designing Architect(Civil Engineer in print) MEASUREMENTS: LENGTH INMETERS HEIGHT IN METERS TYPE OF FENCING Indegenous Materials RC. & Interlink/Cyclone Wire Reinforced Cone. RC. & Steel Matting R.C. & Cone, Hollow R.C. & Barbed Wire & Other Blocks Wires R.C. & Bricks Others (Specify) Box 4 (To be accomplished by the Building Official) ACTION TAKEN: Permit is hereby granted subject to the following conditions: 1. That the proposed construction/addition/repair/renovation shall be in conformity with the National Building Code (P.D. 1096) 2. That the required setback shall be observed. seo oleae ROMUALDO A, DE CASTRO Date ‘Municipal Engineer Note: This permit may be cancelled or revoke pursuant to Selections 305 and 306 of the National Building Code.