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NBC FORM NO. B - 08
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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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DEMOLITION PERMIT
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APPLICATION NO.
DP NO.
BUILDING PERMIT NO.
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BOX 1 (TO BE ACCOMPLISHED BY THE OWNER/APPLICANT)
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OWNER/APPLICANT
LAST NAME
FIRST NAME
MI.
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 OF
ZIP CODE
TELEPHONE NO.
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LOCATION OF DEMOLITION WORKS: LOT NO. _________ BLK NO. _________ TCT NO. _____________ TAX DEC NO. ____________________
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STREET __________
BARANGAY ______________________________
CITY OF SAN FERNANDO, LA UNION
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SCOPE OF WORK
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DEMOLITION _________________________
OTHERS (Specify) _________________________
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_________________________________________
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BOX 2
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FULL-TIME INSPECTOR AND SUPERVISOR OF DEMOLITION WORKS
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ADDRESS
TEL. NO.
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_______________________________________________
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ARCHITECT OR CIVIL ENGINEER
PRC NO.
VALIDITY
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(Seal and Signature Over Printed Name)
PTR NO.
DATE ISSUED
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Date ____________________
ISSUED AT
TIN
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BOX 3 (TO BE ACCOMPLISHED BY THE APPLICANT)
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APPLICANT:
WITH MY CONSENT: LOT OWNER
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______________________________________________________________________________________________
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(Seal and 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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BOX 4
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REPUBLIC OF THE PHILIPPINES
)S.S
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CITY/MUNICIPALITY OF _________________________
)
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BEFORE ME, at the City/Municipality of ______________________________ on ______________________________ personally
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appeared the following:
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APPLICANT
CTC NO.
DATE ISSUED
PLACE ISSUED
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LICENSED ARCHITECT OR CIVIL ENGINEER
CTC NO.
DATE ISSUED
PLACE ISSUED
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(Full-Time Inspector and Supervisor of Demolition Works)
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whose signatures appear herein above, known to me to be the same persons who executed this standard prescribed form and acknowledged to that the same is their free and voluntary act and deed.
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WITNESS MY HAND AND SEAL on the date and place above written.
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Doc. No.
__________
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Page No.
__________
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Book No.
__________NOTARY PUBLIC (Until December ____________)
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Series No.
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