ABCDEFGHIJKLMNOPQRSTUVWXYZ
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NBC FORM NO. A - 07
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Republic of the Philippines
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City of San Fernando
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Province of La Union
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 OFFICE OF THE BUILDING OFFICIAL
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CIVIL/STRUCTURAL PERMIT
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APPLICATION NO.
C/SP NO.
BUILDING PERMIT NO.
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BOX 1 (TO BE ACCOMPLISHED PRINT BY THE OWNER/APPLICANT)
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OWNER/APPLICANT
LAST NAME
FIRST NAME
M.I.TIN
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FOR CONSTRUCTION OWNED
FORM OF OWNERSHIP
USE OR CHARACTER OF OCCUPANCY
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BY AN ENTERPRISE
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ADDRESS:
NO.STREET
BARANGAY
CITY/MUNICIPALITY
ZIP CODETEL. NO.
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LOCATION OF CONSTRUCTION:
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LOT NO.: __________
BLOCK NO.: __________
TCT NO.: _______________
TAX DEC NO.: _______________
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STREET: __________
BARANGAY: ____________________________
CITY/MUNICIPALITY: ______________________
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SCOPE OF WORK
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NEW INSTALLATION
RENOVATION _____________
RAISING_____________________________
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ERECTION
CONVERSION _____________
DEMOLITION _________________________
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ADDITION
REPAIR __________________
ACCESSORY BUILDING STRUCTURE _______
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ALTERATION
MOVING _________________
OTHERS (Specify) _____________________
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BOX 2 (TO BE ACCOMPLISHED BY THE DESIGN PROFESSIONAL)
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NATURE OF CIVIL/STRUCTURAL WORKS:
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STAKING
ERECTION/LIFTING
PRESTRESS WORKS
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EXCAVATION
CONCRETE FRAMING
MATERIAL TESTING
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SOIL STABILIZATION
STRUCTURAL STEEL FRAMING
STEEL TOWERS
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PILING WORKS
SLABSTANKS
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FOUNDATION
WALLS
OTHERS (Specify) _____________________
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BOX 3
BOX 4
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DESIGN PROFESSIONAL, PLANS AND SPECIFICATIONS
SUPERVISION/IN-CHARGE OF CIVIL/STRUCTURAL WORKS
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CIVIL/STRUCTURAL ENGINEERCIVIL/STRUCTURAL ENGINEER
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(Signed and Sealed Over Printed Name)(Signed and Sealed Over Printed Name)
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Date: _________________________________Date: _________________________________
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ADDRESS
ADDRESS
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PRC NO.
VALIDITY:
PRC NO.
VALIDITY:
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PTR NO.
DATE ISSUED
PTR NO.
DATE ISSUED
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ISSUED AT
TIN
ISSUED AT
TIN
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BOX 5
BOX 6
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BUILDING OWNER
WITH MY CONSENT: LOT OWNER
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____________________________________________________________________________________
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(Signature Over Printed Name)(Signature Over Printed Name)
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Date: _________________________________Date: _________________________________
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ADDRESS
ADDRESS
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CTC NO.
DATE ISSUED
PLACE ISSUED
CTC NO.
DATE ISSUED
PLACE ISSUED
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