NBC FORM NO.

A - 02

Republic of the Philippines

City/Municipality of GATTARAN
Province of CAGAYAN
OFFICE OF THE BUILDING OFFICIAL

CIVIL/STRUCTURAL PERMIT
APPLICATION NO. C/SP NO BUILDING PERMIT NO.

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

OWNER/APPLICANT LAST NAME FIRST NAME M.I. TIN

FOR CONSTRUCTION OWNED FORM OF OWNERSHIP USE OR CHARACTER OF OCCUPANCY

BY AN ENTERPRISE
ADDRESS: NO., STREET, BARANGAY, CITY/MUNICIPALITY ZIP CODE TELEPHONE NO

LOCATION OF CONSTRUCTION: LOT NO. _______________ BLK NO. ________________ TCT NO. ______________________ TAX DEC. NO.___________________

STREET___________________ BARANGAY ____________________________________________________ CITY/ MUNICIPALITY OF ______________________________

SCOPE OF WORK
NEW CONSTRUCTION RENOVATION ________________________ RAISING ______________________________________
ERECTION CONVERSION ________________________ DEMOLITION __________________________________
ADDITION REPAIR _____________________________ ACCESSORY BUILDING/STRUCTURE _____________
ALTERATION MOVING _____________________________ OTHERS (Specify) ______________________________

BOX 2 (TO BE ACCOMPLISHED BY THE DESIGN PROFESSIONAL)

NATURE OF CIVIL/STRUCTURAL WORKS:

STAKING ERECTION/LIFTING PRESTRESS WORKS

EXCAVATION CONCRETE FRAMING MATERIAL TESTING
SOIL STABILIZATION STRUCTURAL STEEL FRAMING STEEL TOWERS
PILING WORKS SLABS TANKS
FOUNDATION WALLS OTHERS (Specify)___________________________

ENGR. ANDREA MAE SANCHEZ

PREPARED BY _______________________________________________________________________________________________________________

BOX 3 BOX 4
DESIGN PROFESSIONAL, PLANS AND SPECIFICATIONS SUPERVISOR/IN-CHARGE OF CIVIL/STRUCTURAL WORKS

ENGR. ANDREA MAE SANCHEZ ENGR. ANDREA MAE SANCHEZ

CIVIL/STRUCTURAL ENGINEER CIVIL/STRUCTURAL ENGINEER
(Signed and Sealed Over Printed Name) (Signed and Sealed Over Printed Name)
Date________________________ Date________________________
Address: SCOUT BARRIO, BAGUIO CITY, BENGUET Address: SCOUT BARRIO, BAGUIO CITY, BENGUET
PRC. No.: 0163517 Validity: 05/18/2024 PRC. No: 0163517 Validity: 05/18/2024
PTR. No: 5044132 Date Issued: 02/10/2022 PTR. No: 5044132 Date Issued: 02/10/2022
Issued at: BAGUIO CITY TIN: 333-064-693-000 Issued at: BAGUIO CITY TIN: 333-064-693-000

BOX 5 BOX 6
BUILDING OWNER WITH MY CONSENT: LOT OWNER

(Signature Over Printed Name) (Signature Over Printed Name)

Date___________________ Date___________________

Address Address
C.T.C. No. Date Issued Place Issued C.T.C. No. Date Issued Place Issued

NOTE: THIS PERMIT MAY BE CANCELLED OR REVOKED PURSUANT TO SECTIONS 305 AND 306 OF THE “NATIONAL BUILDING CODE”.