Republic of the P.

hi/ippines
City/Municipality of Si ang
Province of ___;:C::..::a::.cv:...:cit=-=e'--------
OFFICE OF THE BUILDING OFFICIAL

ARCHITECTURAL PERMIT
APPLICATION NO. APNO BUILDING PERMIT NO.

IIIIIIIIIII IIIIIIIII IIIIIIIII

BOX 1 (TO BE ACCOMPLISHED IN PRINT BY THE OWNER/APPLICANT)
OWNER/APPLICANT LAST NAME FIRST NAME M.I. TIN
I

FOR CONSTRUCTION OWNED FORM OF OWNERSHIP USE OR CHARACTER OF OCCUPANCY

I I
BY AN ENTERPRISE
ADDRESS: NO., STREET, BARANGAY, CITY/MUNICIPALITY ZIP CODE TELEPHONE NO
I

LOCATION OF CONSTRUCTION: OT NO. BLK NO. TCT NO. TAX DEC.NO.

STREET BARANGAY CITY/ MUNICIPALITY OF

SCOPE OF WORK
0 NEW CONSTRUCTION 0 RENOVATION 0 RAISING
0 ERECTION 0 CONVERSION 0 ACCESSORY BUILDING/STRUCTURE
0 ADDITION 0 REPAIR 0 OTHERS (Specify)
0 ALTERATION 0 MOVING
BOX 2 (TO BE ACCOMPLISHED BY THE DESIGN PROFESSIONAL)
1. ARCHITECTURAL FACILITIES AND OTHER FEATURES PURSUANT TO BATAS PAMBANSA BILANG 344, REQUIRING CERTAIN BUILDINGS, INSTITUTIONS,
ESTABLISHMENTS AND PUBLIC UTILITIES TO INSTALL FACILITIES AND OTHER DEVICES.
0 STAIRS 0 WASH ROOMS ANO TOILETS 0 SWITCHES, CONTROLS, BUZZERS 0 DRINKING FOUNTAINS
0WAL�AYS 0 LIFTS/ELEVATORS 0 HANDRAILS 0 PUBLIC TELEPHONES
0 CORRIDORS □
RAMPS THRESHOLDS 0 0 SEATING ACCOMMODATIONS
0 DOORS, ENTRANCES & THRESHOLDS 0 PARKING AREAS FLOOR FINISHES
0 0 OTHERS (Specify)

2. PERCENTAGE OF SITE OCCUPANCY 3. CONFORMANCE TO FIRE CODE OF THE PHILIPPINES (P.O. 1185)
PERCENTAGE OF BUILDING FOOTPRINT % 0 NUMBER AND WIDTH OF EXIT DOORS O FIRE WALLS 0 OTHERS (Specify)
PERCENTAGE OF IMPERVIOUS SURFACE AREA __% 0 WIDTH OF CORRIDORS 0 FIRE FIGHTING AND SAFETY FACILITIES
PERCENTAGE OF UNPAVED SURFACE AREA % 0 DISTANCE TO FIRE EXITS 0 SMOKE DETECTORS
OTHERS (Specify) 0 ACCESS TO PUBLIC STREET 0 EMERGENCY LIGHTS

BOX3 BOX4
DESIGN PROFESSIONAL, PLANS AND SPECIFICATIONS SUPERVISOR I IN.CHARGEOF ARCHITECTURAL WORKS

Date Date
ARCHITECT ARCHITECT
(Signed and Sealed Over Printed Name) (Signed and Sealed Over Printed Name )
Address Address
PRC No. I Validity PRC No. IValidity
IAPOANo. IO.R. No. IDate Issued IAPOA No. IO.R. No. IDate Issued
PTR.No IPlace Issued IDate Issued PTR. No lPlace Issued loate Issued
TIN TIN
�
BOX5 BOX&
BUILDING OWNER WITH M'f CONSENT: .LOT OWNER

(Signature Over Prilled Name) (Signature CNer Printed Name)

Date Date
Address
C.T.C. No.
I
Date Issued I Place Issued
Address
C.T.C. No.
I Date Issued
I
Place Issued