Republic of the Philippines

City of Laoag
Province of llocos Norte

UNIFIED APPLICATION FORM FOR CERTIFICATE OF OCCUPANCY

□ FULL 0 PARTIAL

THIS ALSO APPLIES FOR: 0 FIRE SAFETY INSPECTION CERTIFICATE

Building Permit No.: _2402000096
__ _ ___
Date Issued 08 Febuary 2024
FSEC No. 1-IN-012-001
Date Issued 12 January 2024

(Date)
LBS Digital Infrastructure Corporation
Name of ApplicanUOwner:__________________________
(Last Name) (Given Name) (Middle Initial)
Unit
Address of ApplicanUOwner:________7-1Three/Neo Building, 3rd Avenue Corner 30th Street, Bonifacio Global City Taguig
• __________________
________________ ZIP Code.: ___ __ Contact No.: ______

Requirements submitted:

0 3 copies of Certificate of Completion, duly notarized

0 Construction Logbook, signed and sealed by the Owner's Architect or Civil Engineer who undertook full-time
inspection and supervision
D As-Built Plans, signed and sealed by the Owner's Architect or Civil Engineer who undertook full-time inspection and
supervision
0 1 photocopy of the valid licenses of all involved Professionals
0 Captioned photographs of Site and Completed Building/Structure showing front, sides and rear areas,
0 Yellow Card issued by the Electrical Service Provider

45M 3 LEGGED MODIFIED SST (CELL SITE TOWER}

Name of Project: ____________________________
BRGY. 31, TALINGAA.N, LAOAG CITY
Location of Project: ___________________________
Commercial Tower
Use/Character of Occupancy: _____________ _
No. of Storey/s: ____1______________
No. of Units: ___________________
258 sq.m.
Total Gross Floor Area (Square Meters): _____________
Date of Completion: _________________
Submitted by:
JOHN DALE S. PARINAS
APPLICANT/OWNER
(Signature Over Printed Name)
Community Tax Certificate No. ______
Date Issued:. __________
Place Issued: __________
Attested by:
FULL-TIME INSPECTOR OR SUPERVISOR OF CONSTRUCTION

CHRISRTIAN AMIEL P. BRINGAS

ARCHITECT OR CML ENGINEER
(Signed and Sealed Ow,- Prinhld Nsne)
Dale
PRCNo. 0110918 12-19-2024
PTRNo. 1168953 Date Issued 01-05-2024
Issued Ill BANGUED ABRA TIN 276-578-000
CTCNo. . IIssued at •