Building Code of the Philippines(1)

Further certify to my honest belief that the building

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Unformatted text preview: rected. IN WITNESS WHEREOF, I have hereunto affixed my signature this ___________________ day of ________________, 19 ___________ in the _____________________________________________. ____________________________________________ ___________________________________ Owner of Building Owner/s of Lot SIGNED IN THE PRESENCE OF: 1. ___________________________________ 2. _______________________________________ REPUBLIC OF THE PHILIPPINES) S. S. Before me, a Notary Public in and for the ___________________________________________, Philippines, this ____________________________ day of ______________________, 19 __________, personally appeared ________________________________________________________ known to me as the person who executed the foregoing instrument and he/she acknowledged to me that the same is his/her free and voluntary act and deed. Affiant exhibited to me his Residence Tax Certificate No. _______________________________ issued at _____________________ on ___________________ and Tax Account No. _______________ ______________________. IN WITNESS WHEREOF, I have hereunto affixed my hand and notarial seal on the date and place above stated. ________________________________ (NOTARY PUBLIC) Until December 31, 19 ______ Doc. No. Page No. Book No. Series of __________ __________ __________ __________ MPW FORM NO. 77-010-B REPUBLIC OF THE PHILIPPINES MINISTRY OF PUBLIC WORKS OFFICE OF THE BUILDING OFFICIAL ________________________________ District/City/Municipality Area Code ____________ APPLICATION FOR CHANGE OF USE OR OCCUPANCY NAME OF APPLICANT: _____________________________________________________________________________ LAST NAME GIVEN NAME MIDDLE NAME ADDRESS OF APPLICANT: __________________________________________________________________________ LOCATION OF BUILDING: __________________________________________________________________________ (Attached vicinity sketch) USE OR TYPE OF OCCUPANCY: EXISTING __________________________________ PROPOSED ______________________________ OCCUPANT LOAD: EXISTING __________________________________ PROPOSED ______________________________ NO OF STORIES: EXISTING __________________________________ PROPOSED ______________________________ FLOOR AREA: EXISTING _______________ADDITIONAL _____________AREA AFFECTED BY CHANGE ___________ TYPE OF CONSTRUCTION: EXISTING __________________________________ PROPOSED ______________________________ DATE OF COMPLETION OF EXISTING BUILDING ______________________________________________________ BUILDING PERMIT (if any) ___________________________________ DATE ________________________________ ORIGINAL CERTIFICATE OF OCCUPANCY NO. ________________________________________________________ SUBMITTED BY: _________________________________________________ APPLICANT Conforme: _______________________________________ Residence Cert. No. _______________________________________ OWNER OF BUILDING Date Issued ______________________________________________ Place _________________________________...
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