Republic of the Philippines

City/Municiplality of_____________________
Province of ___________________________________
UNIFIED APPLICATION FORM FOR BUILDING PERMIT
SIMPLE STRUCTURE COMPLEX STRUCTURE
NEW RENEWAL AMENDATORY
THIS APPLIES ALSO FOR: LOCATIONAL CLEARANCE FIRE SAFETY EVALUATION CLEARANCE
APPLICATION NO. AREA NO.

BOX 1 (TO BE ACCOMPLISHED IN PRINT BY THE OWNER APPLICANT)

OWNER/APPLICANT: LAST NAME FIRST NAME M.I. TIN DO NOT FILL-UP (PSA USE ONLY)

FOR CONSTRUCTION OWNED FORM OF OWNERSHIP

BY AN ERNTERPRISE
ADDRESS: NO. STREET BARANGAY, CITY/MUNICIPALITY ZIP CODE CONTACT NO.

LOCATION OF CONTRUCTION: LOT NO.______ BLK. NO. _____ TCT NO. _____________ CURRENT TAX DEC.NO. ________
STREET __________ BARANGAY __________________________________ CITY/MUNICIPALITY OF ________________
SCOPE OF WORK
NEW CONSTRUCTION RENOVATION_________________________________ RAISING ____________________________________________
ERECTION _______________________ CONSERVATION ______________________________ ACCESORY BUILDING/STRUCTURE ___________________________
ADDITION _______________________ REPAIR _____________________________________ OTHERS (Specify) ________________________________________
ALTERATION _____________________ MOVING _____________________________________ _____________________________________________
USE OR CHARACTER OF OCCUPANCY GROUP H: ASSEMBLY (OCCUPANT
GROUP A: RESIDENTIAL (DWELLINGS) GROUP E: COMMERCIAL LOAD LESS THAN 1,000)
SINGLE DUPLEX RESIDENTIAL R-1,R-2 BANK STORE SHOPPING THEATER, AUDITORIUM, CONVENTION
OTHERS ___________________________________ DRINKING/ DINING CENTER/ MALL HALL, GRANDSTAND/BLEACHER
GROUP B: RESIDENTIAL ESTABLISHMENT OTHERS ___________________
SINGLE MOTEL TOWNHOUSE SHOP (I.E. DRESS SHOP, TAILORING, GROUP I: ASSEMBLY (OCCUPANT
DORMITORY BOARDINGHOUSE, BARBERSHOP, ect.) LOAD LESS THAN 1,000)
RESIDENTIAL R-3,R-4,R-5 LODGING HOUSE OTHERS _________________________ COLISEUM, SPORTS COMPLEX,
OTHERS ___________________________________ GROUP F: LIGHT INDUSTRIAL CONVENTION CENTER AND SIMILAR
GROUP C: EDUCATIONAL & RECREATIONAL FACTORY/ PLANT (USING INCOMBUSTIBLE/ STRUCTURE
SCHOOL BUILDING SCHOOL AUDITORIUM, NON-EXPLOSIVE MATERIALS OTHERS _________________
CIVIC CENTER GYMNASIUM OTHERS __________________________ GROUP J: (J-1) AGRICULTURAL
CLUBHOUSE CHRUCH, MOSQUE, GROUPG: MEDIUM IDUSTRIAL BARN, GRANARY, POULTRY HOUSE
OTHERS ___________________________________
TEMPLE, CHAPEL STORAGE/ WAREHOUSE (FOR HAZARDOUS/ PIGGERY, GRAIN MILL, GRAIN SILO
GROUP D: INSTITUTIONAL HIGHLY FLAMMABLE MATERIALS OTHERS __________________
HOSPITAL OR SIMILAR STRUCTURE FACTORY (FOR HAZARDOUS/HIGHLY GROUP J: (J-2) ACCESORIES
HOME FOR THE AGED FLAMMABLE MATERIALS PRIVATE CARPORT/ GARAGE, TOWER,
GOVERNMENT OFFICE OTHERS _____________________________ SWIMMING POOL, FENCE OVER 1.80 M,
OTHERS ___________________________________ STEEL/ CONCRETE TANK

OTHERS_______________________
PROPOSE DATE OF START OF CONSTRUCTION IF CONSTRUCTION IS
__________________________________________ TOTAL ESTIMATED COST: P _____________________________________ UNDERTAKEN BY CONTRACT:
OCCUPANCY CLASSIFIED ______________________________ BUILDING _____________________________
COST OF EQUIPMENT INSTALLED:
NUMBER OF UNITS _________________________________ ELECTRICAL _________________________P _______________________
NUMBER OF STOREY _____________________________________MECHANICAL ___________________________
P _______________________ __________________________________
TOTAL FLOOR AREA __________________________SQ. M. ELECTRONICS _________________________
P _______________________ AUTHORIZED MANAGING OFFICER
LOT AREA __________________________________ SQ. M. PLUMBING ___________________________ P _______________________ (Signature Over Printed Name)

BOX 2
FULL-TIME INSPECTOR AND SUPERVISOR OF CONSTRUCTION WORKS (REPRESENTING THE OWNER)
Address
_________________________________
ARCHITECT OR CIVIL ENGINERR PRC No. Validity
(Signature Over Printed Name) PTR No. Date Issued
Date ____________________ Issued at TIN
BOX 3 BOX 4
APPLICANT:
WITH MY CONSENT: LOT OWNER/ AUTHORIZED REPRESENTATIVE

_________________________________Date ___________ _________________________________Date ___________

(Signature Over Printed Name) (Signature Over Printed Name)
Address Address
Gov't issued ID No. Date issued Place Issued Gov't issued ID No. Date issued Place Issued
BOX 5
REPUBLIC OF THE PHILIPPINES )
CITY/ MUNICIPALITY OF _____________________________________)
BEFORE ME, at the City/Municipality of ________________________________________, on ______________________________ personally appeared the following:

______________________________________________________ _____________________________ _______________________ _______________________

APPLICANT Gov't Issued ID No. Date Issued Place Issued

_________________________________________________ _____________________________ _______________________ _______________________

LICENSED ARCHITECT OR CIVIL ENGINEER Gov't Issued ID No. Date Issued Place Issued
(Full-time Inspector and Supervisor of Construction Works)

whose signature appear hereinabove, known to me to be the same persons who executed this standard prescribed form and acknowledged to me that the same is their free and voluntary act
and deed.
WITNESS MY HAND AND SEAL on the date and place above written.
Doc. No. __________
Page No. __________ __________________________________________
Book No. __________ NOTARY PUBLIC (until December _____)
Series of __________
Copy 1: Owner Copy 2:OBO Copy 3: BFP Copy 4: Philippine Statistics Authority