REPUBLIC OF THE PHILIPPINES

QUEZON CITY
DEPARTMENT OF THE BUILDING OFFICIAL

APPLICATION FOR FENCING PERMIT

APPLICATION NO.
DATE OF APPLICATION:

BOX 1 (TO BE ACCOMPLISHED IN PRINT BY THE OWNER/APPLICANT) AND BY THE DESIGN PROFESSIONAL
OWNER/APPLICANT LAST NAME FIRST NAME M.I. TIN

FOR CONSTRUCTION OWNED BY AN FORM OF OWNERSHIP

ADDRESS NO. STREET, BARANGAY, CITY/MUNICIPALITY ZIP CODE TEL. NO.

LOCATION OF CONSTRUCTION: LOT NO.: __________________ BLK NO.: _____________________ TCT NO. TAX DEC. NO.
STREET: _____________________________________________________ BARANGAY: __________________________________________, QUEZON CITY
SCOPE OF WORK:
NEW CONSTRUCTION REPAIR ________________________________ OTHERS (Specify) ___________________________________
ERECTION ____________________ DEMOLITION ___________________________
ADDITION ______________________

BOX 2 ( TO BE ACCOMPLISHED BY DESIGNING ARCHITECT / CIVIL ENGINEER / CONTRACTOR IN PRINT )

MEASUREMENTS IN METERS: FENCE LENGTH: _______________________________ EXCESS_____________________

FENCE HEIGHT: _______________________________ PROJECT COST: ________________

TYPE OF FENCING:
INDIGENOUS R.C. & BRICKS R.C. & BARBED WIRE & OTHER WIRES
R.C. ( REINFORCED CONCRETE ) R.C. & INTERLINK / CYCLONE WIRE OTHERS________________________
R.C. & CONCRETE HOLLOW BLOCKS R.C. & STEEL MATTING

BOX 3 BOX 4
DESIGN PROFESSIONAL, PLANS AND SPECIFICATIONS FULL-TIME INSPECTOR AND SUPERVISOR OF CONSTRUCTION WORKS

ARCHITECT OR CIVIL ENGINEER ARCHITECT OR CIVIL ENGINEER

(Signed and Sealed Over Printed Name) (Signed and Sealed Over Printed Name)
Date Date

Address Address

PRC No. Validity PRC No. Validity

PTR No. Date Issued PTR No. Date Issued

Issued at TIN Issued at TIN

BOX 5 (TO BE ACCOMPLISHED BY THE APPLICANT / OWNER)

APPLICANT: WITH MY CONSENT: LOT OWNER

(Signature Over Printed Name) (Signature Over Printed Name)

Date Date

Address Address

CTC No. Date Issued Place Issued CTC No. Date Issued Place Issued

BOX 6

REPUBLIC OF THE PHILIPPINES

) S. S.
CITY/MUNICIPALITY OF __________________________________

BEFORE ME, at the City/Municipality of ____________________________________________________________, on __________________________personally appeared

_____________________________________________ ________________ _________________ ________________

APPLICANT C.T.C. No. Date Issued Place Issued

_____________________________________________ ________________ _________________ ________________

LICENSED ARCHITECT OR CIVIL ENGINEER C.T.C. No. Date Issued Place Issued
(Full-Time Inspector and Supervisor of Construction Work)

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

QCG-DBO-CPA06-V01