BOX 1(TO BE ACCOMPLISHED BY THE APPLICANT)

OWNER/APPLICANT	LAST NAME	FIRST NAME	M.I	TIN (Tax Identification Number) Invalid or incomplete TIN format. Please enter 12 digits in the format 000-000-000-000.
FOR CONSTRUCTION OWNED BY ENTERPRISE			FORM OF OWNERSHIP
Address:
street no.	Barangay Select Barangay Brgy CojuangcoBrgy La FuenteBrgy LiwaywayBrgy MalacanangBrgy AquinaldoBrgy BerangBrgy BurgosBrgy Del PilarBrgy GomezBrgy InspectorBrgy IslaBrgy LourdesBrgy LunaBrgy MabiniBrgy MaliolioBrgy MapaladBrgy Rajal CentroBrgy Rajal NorteBrgy Rajal SurBrgy RizalBrgy San GregorioBrgy San IsidroBrgy San JosepBrgy San MarianoBrgy San PedroBrgy Santa TerisitaBrgy Santo RosarioBrgy SapsapBrgy SoledadBrgy TagposBrgy TramoBrgy ValenzuelaBrgy Zamora	City/Municipality Santa Rosa, Nueva Ecija	ZIP Code	Contact No. +63  Please enter a valid contact number (must start with 9 and have 10 digits).
Email	Please use a valid Email.
LOCATION OF CONSTRUCTION:
Lot No.		Blk No.	TCT No.	Current Tax DEC. NO.
street no.		Barangay Select Barangay Brgy CojuangcoBrgy La FuenteBrgy LiwaywayBrgy MalacanangBrgy AquinaldoBrgy BerangBrgy BurgosBrgy Del PilarBrgy GomezBrgy InspectorBrgy IslaBrgy LourdesBrgy LunaBrgy MabiniBrgy MaliolioBrgy MapaladBrgy Rajal CentroBrgy Rajal NorteBrgy Rajal SurBrgy RizalBrgy San GregorioBrgy San IsidroBrgy San JosepBrgy San MarianoBrgy San PedroBrgy Santa TerisitaBrgy Santo RosarioBrgy SapsapBrgy SoledadBrgy TagposBrgy TramoBrgy ValenzuelaBrgy Zamora	City/Municipality Santa Rosa, Nueva Ecija
Scope of Works New Construction Erection Addition Alteration Renovation Conversion Repair Moving Raising Accesory Building/Structure Legalization of Existing Building Others (SPECIFY) Please select at least one of scope of works.

USE OF CHARACTER OF OCCUPANCY
GROUP A: RESIDENTIAL (DWELLINGS) SINGLE DUPLEX RESIDENTIAL R-1,R-2 Others:		GROUP E: COMMERCIAL BANK STORE SHOPPING CENTER/MALL DRINKING/DINING ESTABLIHMENT SHOP(i.e. DRESS SHOP, TAILORING,BARBERSHOP,etc) OTHERS		GROUP H: ASSEMBLY (OCCUPANT LOAD LESS THAN 1,000) THEATER, AUDITORIUM, CONVENTION HALL, GRANDSTAND/BLEACHER Others:
GROUP B: RESIDENTIAL HOTEL DORMITORY RESIDENTIAL R-3,R-4,4-5 MOTEL TOWNHOUSE BOARDINGHOUSE LODGINGHOUSE Others:		GROUP F: LIGHT INDUSTRIAL FACTORY/PLANT (USING INCOMBUSTIBLE/NON-EXPLOSIVE MATERIALS) OTHERS		GROUP I: ASSEMBLY (OCCUPANT LOAD LESS THAN 1,000 OR MORE) THEATER, AUDITORIUM, CONVENTION HALL, GRANDSTAND/BLEACHER Others:
GROUP C: EDUCATIONAL & RECREATIONAL SCHOOL BUILDING CIVIC CENTER CLUBHOUSE SCHOOL,AUDITORIUM, GYMNASIUM CHURCH, MOSQUE, TEMPLE, CHAPEL Others:		GROUP G: MEDIUM INDUSTRIAL STORAGE/WAREHOUSE(FOR HAZARDOUS)/HIGHLY FLAMMABLE MATERIALS FACTORY(FOR HAZARDOUS/HIGHLY FLAMMABLE MATERIALS) OTHERS		GROUP J:(J-1)AGRICULTURAL BARN, GRANARY, POULTRY HOUSE, PIGGERY, GRAIN MILL, GRAIN SILI Others:
GROUP D: INSTITUTIONAL HOSPITAL OR SIMILAR STRUCTURE HOME FOR THE AGED GOVERNMENT OFFICE Others:				GROUP J:(J-2)ACCESSORIES PRIVATE CARPORT/GARAGE, TOWER, SWIMMING POOL, FENCEOVER 1.80M, STEEL, CONCRETE TANK Others:

OCCUPANCY CLASSIFIED :			TOTAL ESTIMATED COST:
NUMBER OF UNITS:		BUILDING:		COST OF EQUIPMENT INSTALLED:
NUMBER OF STOREY:		ELECTRICAL:		P
TOTAL FLOOR AREA:		MECHANICAL:		P
LOT AREA:		ELECTRONICS:		P
		PLUMBING		P
PROPOSED DATE OF CONSTRUCTION:			EXPECTED DATE OF COMPLETION:

Submit
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