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Temporary Sidewalk Enclosure and Occupancy Permit (Front)

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NBC FORM NO.

B - 05

Republic of the Philippines


Department of Public Works & Highways
Pamahalaang Lungsod ng Heneral Santos
TANGGAPAN NG PINUNONG PANGGUSALI
(Office of the Building Official)

TEMPORARY SIDEWALK
ENCLOSURE AND OCCUPANCY PERMIT

APPLICATION NO. TSEOP NO BUILDING PERMIT NO.

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


OWNER/APPLICANT LAST NAME FIRST NAME MIDDLE NAME 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 ________________________ DEMOLITION __________________________________
ERECTION CONVERSION ________________________ ACCESSORY BUILDING/STRUCTURE _____________
ADDITION REPAIR _____________________________ OTHERS (Specify) ______________________________
ALTERATION MOVING _____________________________ ______________________________________________

BOX 2 BOX 3
DESIGN PROFESSIONAL, PLANS AND SPECIFICATIONS FULL-TIME INSPECTOR AND SUPERVISOR OF CONSTRUCTION WORKS

Date___________ Date___________
ARCHITECT OR CIVIL ENGINEER ARCHITECT OR CIVIL ENGINEER
(Signed and Sealed Over Printed Name) (Signed and Sealed Over Printed Name)
Address Address
PRC. No Validity PRC. No Validity
PTR. No Date Issued PTR. No Date Issued
Issued at TIN Issued at TIN
BOX 4 BOX 5
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

BOX 6

APPLICANT
(Signature Over Printed Name)
Date________________
CTC NO. DATE ISSUED PLACE ISSUED

TIN

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