DATE: REQUIREMENTS FOR CERTIFICATE OF OCCUPANCY NAME : LOCATION / ADDRESS: INSPECTION/ REMARKS [Photo copy of BUILDING PERMIT FORMS Fully accomplished Completion form/ UNIFIED APPLICATION FORM CERTIFICATEOF OCCUPANCY Photo copy of FIRE SAFETY INSPECTION CERTIFICATION (FSIC)- BFP lPhotocopy of PTR/PRC - Architect/ Civil Engineer In-cherged in Construction [construction LOGBOOK duly signed and sealed by Architect/Civil Engineer in-charged in Construction |Approved Plan issued by the City Building Official for Verification purposes CONTROL #: CP NO, : INSPECTORS:GtBY HUI NU. /-010-8 REPUBLIC OF THE PHILIPPINES PROVINCE OF BULACAN OFFICE OF THE CITY BUILDING OFFICIAL SITY OF SAN JOSE DEL MONTE, BULACAN Ditriet/Cty/ Muna ry ‘res Code: 870 8 APPLICATION FOR CHANGE OF USE OF OCCUPANCY NAME OF APPLICANT: ani ast Ware) ‘Given ame) ‘te int) '|ADDRESS OF APPLICANT: ae = LOCATION OF BUILDING: % zi {attach vieinity sketch) ‘USE OR TYPE.OCCUPANCY ORSTING roses ‘ PROPOSED OCCUPANT LOAD: EXISTING na PROPOSED NO, OF STORIES. = EXISTING am PROPOSED FLOOR AREA: EXISTING _____ADDITIONAL. AREA AFFECTED BY CHANGE ‘TYPE OF CONSTRUCTION: ae a ‘EXISTING es Sass PROPOSED DATE OF COPLETION OF EXISTING BUILDING [BUILDING PERMIT {if any) me Sass DATE ‘ORIGINAL CERTIFICATE OF OCCUPANCY RO. one SUBMITTED BY: CONFORME: ‘APPLICANT Residence Cert. NO. Date issued Place OWNER OF BUILDING ARCH, PAVEL D. HALOG City Building Official Date:UOBY FUR NU-//-U10-8 REPUBLIC OF THE PHILIPPINES PROVINCE OF BULACAN OFFICE OF THE CITY BUILDING OFFICIAL SITY OF SAN JOSE DEL MONTE, BULACAN, Distret/Chy/Munielpaiy Area Code: 14208 APPLICATION FOR CHANGE OF USE OF OCCUPANCY . NAME OF APPLICANT: zo i iss ‘(hast Mame) (Given name) ‘(Middle initial) ADDRESS OF APPLICANT: fies ates e {LOCATION OF BUILDING: pal s a {attach vicity sketch) \USE.OR TYPE OCCUPANCY exising = PROPOSED OCCUPANT LOAD: Nas PROPOSED NO, OF STORIES. : EXISTING Sone PROPOSED: FLOOR AREA: EXISTING ADDITIONAL is AREA AFFECTED BY CHANGE ‘TYPE OF CONSTRUCTION: = EXISTING Boe PROPOSED DATE OF COPLETION OF EXISTING ‘BUILDING BUILDING PERMIT {if any) a DATE ORIGINAL CERTIFICATE OF OCCUPANCY NO. ‘SUBMITTED BY: ‘CONFORME: ‘APPLICANT Residence Cert. NO. Date issued Place OWNER OF BUILDING ARCH, PAVEL D. HALOG City Building Offical Date: