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Demolition Permit Front

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NBC FORM NO.

B - 08

Republic of the Philippines


CITY OF CALAMBA
Province of Laguna

OFFICE OF THE BUILDING OFFICIAL

DEMOLITION PERMIT
APPLICATION NO. DP NO BUILDING PERMIT NO.

BOX 1 (TO BE ACCOMPLISHED 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 DEMOLITION WORKS: LOT NO. _______________ BLK NO. ________________ TCT NO. _____________________ TAX DEC. NO. _________________
STREET___________________ BARANGAY ____________________________________________________ CITY/ MUNICIPALITY OF ________________________________

SCOPE OF WORK
DEMOLITION __________________________________ OTHERS (Specify) _____________________________________
_____________________________________________________

BOX 2

FULL-TIME INSPECTOR AND SUPERVISOR OF DEMOLITION WORKS


Address Tel. No.
PRC. No Validity
ARCHITECT OR CIVIL ENGINEER PTR. No Date Issued
(Seal and Signature Over Printed Name)
Date__________________________ Issued at TIN

BOX 3 (TO BE ACCOMPLISHED BY THE APPLICANT)

APPLICANT: 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 4

REPUBLIC OF THE PHILIPPINES )


S.S
CITY/MUNICIPALITY OF _______________________)
BEFORE ME, at the City/Municipality of _______________________________________________, on ___________________________ personally
appeared the following:

APPLICANT CTC No. Date Issued Place Issued

LICENSED ARCHITECT OR CIVIL ENGINEER CTC No. Date Issued Place Issued
(Full-Time Inspector and Supervisor of Demolition Works)

whose signatures appear herein above, known to me to be the same persons who executed this standard prescribed form and acknowledged to me that the same is their
free and voluntary act and deed.
WITHNESS MY HAND AND SEAL on the date and place above written.
Doc. No. _______________
NOTARY PUBLIC (Until December______________________)
Page No. _______________
Book No. _______________
Series No. _______________

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