Republic of the Philippines DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS OFFICE OF THE BUILDING OFFICIAL SAN RAFAEL, BULACAN APPLICATION NO. SANITARY/PLUMBING PERMIT Date of Application BOX 1 (To be accomplished by Sanitary Engineer/Master Plumber in Print) NAME OF OWNERVAPPLICANT. LAST NAME MAL. ADDRESS STREET _ New Installation USE OR TYPE OF OCCUPANCY Residential ~ Commercial Industri Institut FIXTURES TO BE INSTALLED NEW EXISTING KIND OF NEW EXISTING KIND OF QTY, FIXTURES FJXTURES FIXTURES QTY, FIXTURES FIXTURES FIXTURES _ _ ee Water Closet __ __. _..._____Bidette Floor Drain Laundry Tray - Lavatories = Dental Cus — Kitchen Sink Gas Heater Faucet Elec. Heater = Shower Head Water Boiler __ Water Meter — Dkg. Fountain Grease Trap Bar Sink "Bath Tube ~ Slop Sink Urinal ~ Air Con, Unit ~ Water tank/ Resevior Sanitary Sewer WATER SUPPLY "SYSTEM OF DISPOSAL ______ Shallow Well ‘Waste water treatment plant Deep Well & Pump Set Septic Vault IMMOFF Tank ~ City/Mur.water system Others NUMBER OF STOREVS OF BUILDING Sanitary sewer connection Sub-surfaces and Filter TOTAL AREA OF BUILDING/SUBDIVISION sqm. PROPOSED DA’ START OF INSTALLATION _ EXPECTED DAE OF COMPLETICN TOTAL COST OF INSTALLATION _ a PREPARED BY: BOX 2 (To be accomplished by Building Official) ACTION TAKEN: Permitis hereby granted to install the sanitary/plambing fixtures enumerated. herein subject te the following conditions: 1, That the proposed installation shall be in accordance with approved plans filed with this office ad in conformity with the National Building Code. 2. That a duly Leensed Sanitary Enge./Master Plumber he engaged to undertake the instalationonstruction ROMUALDO A. DE CASTRO Building Official 3. That a Certiicate of Completion duly signed by a Sanitary Engr /Master Plumber in-charge o' the instalation shall be submited not later than seven (7) days after — — ccompletior ofthe installation, DATE 4. ‘That a Cerificate of Final Insp. And a Certificate of Occupancy be secured prior to the actual eccupancy of the building,ura __sstuaay - SINYNINTYd ony en FF SATE GS=U 2qUIN|Y soseYsoOUIsEY KEES 1X08 SILLVNOIS ‘Gans! —aansst ow || _Ganssigovid_____aansstaiva__oN'W'd ADV Id LW PREREELE ~_INvoriady “| |} ——— ae _ ssayaay, - SIAVN LNMd SUOTTRNU SAIS ¥ SUT P pauas ont OWE gun} srsepssourag Are UeS 9 XO8 19104] UOT BULLOFUI axf 0} KyTULIO}UOD sno BUIApUBIS spuBY ano XIE kq—LH| 2M - ‘Aree | (apeip pu Sur) nap0aH ‘Faypsosay pur Busaloooy a a ORDER OTSIATC BUISSONL NID ino Ni aaion | ‘MOT SSTUDOW (Paus20109 uonsagjuoisinicy Aq paysitdusoooe #9 01) § KOM diva aiva ‘A@ GaSSaSsv_ and LNAOWV, ‘Saad Gassassv (pauaou0s uonsag/uorsiarcy Aq poysy|duioooe aq OL) XOM (Grseds) sia steuorew jo 1 Soret 1809 ~ oneoyroads 9 suxig Buiquinyg GeuEs SLN3WN00d ONIN (wonsag Surpsosey pure Sujajaoay ayp L -yWugns 2q uoHE|pEIsUI Jo FeYo-UE NVIONILOG 1d NALS WIN / HAINIONT AVIDO ONIGUAG —"TVORALOATA Ue Aq poudis KInp NOLLATIWOD dO ALVITLLYAD VIPUL OE OUISVD 3d ¥ OGTVAWON cuoyanuasuod / uouE|Est aut axMi9pUN OF pafesuD og NVIOWLOA TA YALSVIN / AAANIONS TYORI.L IATA Pesuansy AIMP PHYTO i ‘ago ONICUNE TYNOLLYN 248 qaim Auguszojuioo uy pu 904440 SHH LALA POL | sued panoudde yum souppiosge us oq joys uowEytmIsut pasodosd 949 IH} OL | ‘SNOLLIGNOO ONIMOTIOS SHL OL LOANS NIAWIH O3.LVASWNNS LNT) AOT GNV NTH TVORLLOSTA TIVISNI OL GAINVD ABTAH SILINWT XV NOLLOV — — —— ne (CIVIOLO ONIGTIO HEL A@ GAHSITMNODOV A OL) 6 XOF ava Lv saad a: AWORLOaTA | ONIGYOOM! GNY ONIATI ITA '@LWd AW. ALVG SLL — NOISIAIG DNISSADONd “AATHO | RIVWIWNOLLOV. Od SSPADOWd (paursouos uonsog / worsiaicy q paystduoose of) L XO ___ALITVdIOINOIN / ALIOAVONVES ssaaaay | TW SINVN.LSMLL SINWN LSV'T LNVONTddY / UANMO JO AINVN | ‘ON NOLLVO1dLLNACI (ouud wy mepouns9'] soiseyy / waouiBusy eaNoa| "| FoUOESSAyoIg Aq Payst{dUODE 9q0]) 9 XOF