Sanitary Permit 2e3t48

Republic of the Philippines OFFICE OF THE BUILDING OFFICIAL Lucena City

SANITARY / PLUMBING PERMIT APPLICATION NO. _______________________ _______________________ Date of Application

PERMIT NO. _________________________ _________________________ Date Issued

Box 1 (TO BE ACCOMPLISHED BY SANITARY ENGINEER / MASTER PLUMBER, IN PRINT) NAME OF APPLICANT

LAST NAME

FIRST NAME

M.I.

TAX ACCT. NO.

ADDRESS

NO. OF STREET/BARANGAY/CITY/MUNICIPALITY

LOCATION OF THE INSTALLATION

NO. OF STREET/BARANGAY/CITY/MUNICIPALITY

SCOPE OF WORK

Addition of ________________________ Repair of __________________________ Removal of ________________________

OTHERS (specify) __________________________________ __________________________________

New Installation _ USE OR TYPE OF OCCUPANCY Residential Commercial Industrial Institutional

___________________________ ___________________________ ___________________________ ___________________________

Agricultural ___________________________ Parks, Plaza & Monuments __________________ Recreational ___________________________ Others (specify) ___________________________

FIXTURES TO BE INSTALLED : Qty. ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( )

New ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( )

Existing ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( )

Kind of Fixtures Water Closet Floor Drain Lavatories Faucets Kitchen Sink Shower Head Water Meter Grease Trap Bath Tubs Slop Sink Urinal Air Conditioning Unit Water Tank Reservoir

_______ Water Distribution System

Qty. ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( )

New ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( )

____________ Sanitary System

Existing ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( )

Kind of Fixtures Bidette Laundry Trays Dental Cuspidor Gas Heater Elec. Heater Water Boiler Drinking Fountain Bar Sink Soda Fountain Sink Lavatory Sink Sterlizer Swimming Pool Others (specify)

__________ Storm Drainage System

WATER SUPPLY : Shallow Well Deep Well & Pump Set City/Municipality Water System Others ____________________

System Disposal Waste Water Treatment Plant Septic Vault/Imhoof Tank Sanitary Sewer Connection

Surface Drainage Street Canal Water Course

Number of Storey of Building Total Area of Building / Subdivision ________________________ ________________________sq.m. Disposal Date ____________ Total Cost of Installation Start of Installation ________ ____________________________ Expected Date of Completion Prepared by : ________________________ ____________________________ Box 2 (TO BE ACCOMPLISHED BY THE RECEIVING & RECORD SECTOR) SANITARY PLUMBING PLANS & SPECIFICATION BILL OF MATERIALS

BUILDING DOCUMENTS COST ESTIMATES OTHERS (SPECIFY)