ABCDEFGHIJKLMNOPQRSTUVWXYZ
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NBC FORM NO. A - 01
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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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ARCHITECTURAL PERMIT
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APPLICATION NO.
AP 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 CODE
TEL. 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 OF SAN FERNANDO, LA UNION
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SCOPE OF WORK
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NEW INSTALLATION
RENOVATION _____________
RAISING___________________________
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ERECTION
CONVERSION _____________
ACCESSORY BUILDING STRUCTURE ____
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ADDITION
REPAIR __________________
OTHERS (Specify) ___________________
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ALTERATION
MOVING _________________
______________________________
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BOX 2 (TO BE ACCOMPLISHED BY THE DESIGN PROFESSIONAL)
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1. ARCHITECTURAL FACILITIES AND OTHER FEATURES PURSUANT TO BATAS BILANG 344, REQUIRING CERTAIN BUILDINGS, INSTITUTIONS, ESTABLISHMENTS AND PUBLIC UTILITIES TO INSTALL FACILITIES AND OTHER DEVICES.
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STAIRS
WASH ROOMS AND TOILETS
SWITCHES, CONTROLS, BUZZERS
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WALKWAYS
LIFTS/ELEVATORS
HANDRAILS
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CORRIDORS
RAMPS
THRESHOLDS
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DRINKING FOUNTAINS
PARKING AREAS
FLOOR FINISHES
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DOORS, ENTRANCES & THRESHOLDS
PUBLIC TELEPHONES
SEATING ACCOMMODATIONS
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OTHERS (Specify) ____________________
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2. PERCENTAGE OF SITE OCCUPANCY
3. CONFORMANCE TO FIRE CODE OF THE PHILIPPINES (PD. 1185)
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PERCENTAGE OF BUILDING FOOTPRINT ________________%
NUMBER AND WIDTH OF EXIT DOORS
FIRE FIGHTING AND SAFETY FACILITIES
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PERCENTAGE OF IMPERVIOUS SURFACE AREA __________%
WIDTH OF CORRIDORS
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PERCENTAGE OF UNPAVED SURFACE AREA _____________%
DISTANCE TO FIRE EXITS
SMOKE DETECTORS
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OTHERS (SPECIFY) _________________________________
ACCESS TO PUBLIC STREET
EMERGENCY LIGHTS
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FIRE WALLS
OTHERS (SPECIFY)
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____________________
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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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ARCHITECTARCHITECT
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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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