Republic of the Philippines
City of Iloilo
Province of Iloilo
OFFICE OF THE BUILDING OFFICIAL
UNIFIED APPLICATION FORM FOR BUILDING PERMIT
HIGHLY
SIMPLE TECHNICAL
COMPLEX*
NEW RENEWAL AMENDATORY
THIS APPLIES ALSO FOR: LOCATIONAL CLEARANCE FIRE SAFETY EVALUATIONCLEARANCE
APPLICATION NO. AREA NO.
BOX 1 (TO BE ACCOMPLISHED IN PRINT BY THE APPLICANT)
OWNER / APPLICANT LAST NAME FIRST NAME M.I. TIN
DO NOT FILL-UP (PSA USE ONLY)
FOR CONSTRUCTION OWNED FORM OF OWNERSHIP
BY AN ENTERPRISE
ADDRESS:NO., STREET, BARANGAY, CITY / MUNICIPALITY ZIP CODE CONTACT NO.
LOCATION OF CONSTRUCTION: LOT NO. _______ BLK NO. ________ TCT NO. ______________ CURRENT TAX DEC. NO. ____________________
STREET_____________________ BARANGAY __________________________ CITY / MUNICIPALITY OF_____________________________________
SCOPE OF WORK
NEW CONSTRUCTION RENOVATION RAISING
ERECTION CONVERSION ACCESSORY BUILDING/STRUCTURE
ADDITION REPAIR LEGALIZATION OF EXISTING BUILDING
ALTERATION MOVING OTHERS (Specify)
USE OR CHARACTER OF OCCUPANCY GROUP H : ASSEMBLY (OCCUPANT
GROUP A : RESIDENTIAL (DWELLINGS) GROUP E : COMMERCIAL LOAD LESS THAN 1,000)
SINGLE DUPLEX RESIDENTIAL R-1, R-2 BANK STORE SHOPPING THEATER, AUDITORIUM, CONVENTION HALL,
OTHERS ______________________________________ DRINKING / DINING CENTER / MALL GRANDSTAND/ BLEACHER
GROUP B : RESIDENTIAL ESTABLISHMENT OTHERS ______________________________
HOTEL MOTEL TOWNHOUSE SHOP (i.e. DRESS SHOP, TAILORING,
DORMITORY BOARDINGHOUSE, BARBERSHOP, etc.) GROUP I : ASSEMBLY (OCCUPANT
RESIDENTIAL R-3, R-4, R-5 LODGING HOUSE OTHERS ______________________________ LOAD 1,000 OR MORE)
OTHERS _______________________________________ GROUP F : LIGHT INDUSTRIAL COLISEUM, SPORTS COMPLEX,
CONVENTION CENTER AND SIMILAR
GROUP C : EDUCATIONAL & RECREATIONAL FACTORY / PLANT (USING INCOMBUSTIBLE/ STRUCTURE
SCHOOL AUDITORIUM,
SCHOOL BUILDING NON-EXPLOSIVE MATERIALS OTHERS _______________________
GYMNASIUM OTHERS ______________________________
CIVIC CENTER
CLUBHOUSE CHURCH, MOSQUE, GROUP J : (J-1) AGRICULTURAL
TEMPLE, CHAPEL GROUP G : MEDIUM INDUSTRIAL BARN, GRANARY, POULTRY HOUSE,
OTHERS _______________ STORAGE / WAREHOUSE (FOR HAZARDOUS/ PIGGERY, GRAIN MILL, GRAIN SILO
GROUP D : INSTITUTIONAL HIGHLY FLAMMABLE MATERIALS OTHERS _______________________
HOSPITAL OR SIMILAR STRUCTURE FACTORY (FOR HAZARDOUS/ HIGHLY GROUP J : (J-2) ACCESSORIES
HOME FOR THE AGED FLAMMABLE MATERIALS PRIVATE CARPORT / GARAGE, TOWER,
GOVERNMENT OFFICE OTHERS _______________________________ SWIMMING POOL, FENCE OVER 1.80m,
STEEL / CONCRETE TANK
OTHERS _______________________________________ OTHERS _______________________
OCCUPANCY CLASSIFIED_____________________________ TOTAL ESTIMATED COST: P ______________________________________
NUMBER OF UNITS__________________________________ BUILDING ____________________________ COST OF EQUIPMENT INSTALLED:
NUMBER OF STOREY________________________________ ELECTRICAL ____________________________ P ______________________________
TOTAL FLOOR AREA ___________________________ SQ. M. MECHANICAL____________________________ P ______________________________
LOT AREA ____________________________________ SQ. M ELECTRONICS___________________________ P ______________________________
PLUMBING ___________________________ P ______________________________
PROPOSED DATE OF CONSTRUCTION: _______________________________ EXPECTED DATE OF COMPLETION: _______________________________
BOX 2
FULL-TIME INSPECTOR AND SUPERVISOR OF CONSTRUCTION WORKS (REPRESENTING THE OWNER)
Address
PRC No. Validity
ARCHITECT OR CIVIL ENGINEER
(Signed and Sealed Over Printed Name) PTR No. Date Issued
Date_____________________________ Issued at TIN
BOX 3 BOX 4
APPLICANT: WITH MY CONSENT: LOT OWNER / AUTHORIZED REPRESENTATIVE
Date ______________ Date______________
(Signature Over Printed Name) (Signature Over Printed Name)
Address Address
Gov’t Issued ID No. Date Issued Place Issued Gov’t Issued ID No. Date Issued Place Issued
BOX 5
REPUBLIC OF THE PHILIPPINES ) S.S
CITY/MUNICIPALITY OF _________________________________________)
BEFORE ME, at the City/Municipality of _____________________________________________________ , on _________________________ personally appeared the
following:
______________________________________________________ _____________________ _______________ ___________________________________
APPLICANT Gov’t. Issued ID No. Date Issued Place Issued
______________________________________________________ _____________________ _______________ ___________________________________
LICENSED ARCHITECT OR CIVIL ENGINEER Gov’t. Issued ID No. Date Issued Place Issued
(Full-Time Inspector and Supervisor of Construction Works)
whose signatures appear hereinabove, 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.
WITNESS MY HAND AND SEAL on the date and place above written.
Doc. No. ____________
Page No.____________ ________________________________________________________
Book No.____________ NOTARY PUBLIC (Until December _____________ )
Series of ____________
Copy 1: Owner (WHITE) Copy 2: OBO (BLUE) Copy 3: BFP (YELLOW) Copy 4: Philippine Statistics Authority (GREEN)
*May require additional requirements
BOX 6 (TO BE ACCOMPLISHED BY THE PROCESSING AND EVALUATION DIVISION)
BASIS OF AMOUNT
ASSESSED FEES ACCOUNT ASSESSED BY
ASSESSMENT DUE
FOR ZONING (ZONING
ADMINISTRATOR):
LOCATIONAL / ZONING OF LAND
FOR BUILDING / STRUCTURE (OBO):
FILING FEE
LINE AND GRADE (Geodetic)
FENCING
ARCHITECTURAL
CIVIL / STRUCTURAL
ELECTRICAL
MECHANICAL
SANITARY
PLUMBING
ELECTRONICS
INTERIOR
SURCHARGES
PENALTIES
FOR FIRE SAFETY (BFP):
FIRE CODE CONSTRUCTION TAX
HOTWORKS
TOTAL
TERMS AND CONDITIONS:
1. The Owner/Applicant shall accomplish the prescribed Application Form, with the assistance of the concerned design
professional/s and/or the Architect/Civil Engineer, hired/commissioned by him/her as full-time inspector/supervisor of
the construction works, by filling up the necessary data / information required thereat.
2. The fully accomplished prescribed Application Form, duly notarized, shall be submitted to the concerned Office of the
Building Official, accompanied by the various applicable ancillary and accessory permits, plans and specifications
signed and sealed by the corresponding design professionals who shall be responsible for the comprehensive and
correctness of the plans in compliance to the National Building Code of the Philippines (PD 1096), its Revised IRR and
all applicable referral codes and professional regulatory laws, together with the other documentary requirements
pursuant to Section 302 of PD 1096 and its Revised IRR.
“I UNDERTAKE that all information in this application is true and correct based on my personal knowledge
and authentic records submitted to Office of the Building Official, Iloilo City. Any false or misleading
information supplied or production of fake / falsified documents shall be grounds for appropriate legal action
against me and automatically revokes the permit. I hereby agree that all personal data (as defined under
the Data Privacy Law of 2012 and its Implementation Rules and Regulations) and account transaction
information or records with the Local Government of Iloilo may be processed, profiled or shared to
requesting parties or for the purpose of any court, legal process, examination, inquiry and audit or
investigation of any authority.”
______________________________________
Signature of printed name of Owner / Applicant
