Demolition Permit

Republic of the Philippines OFFICE OF THE BUILDING OFFICIAL Lucena City AREA CODE : 042 APPLICATION NO : ______________________________ ______________________________ Date of Application

PERMIT NO. ________________________________ ________________________________ Date of Completion

DEMOLITION PERMIT APPLICATION I HAVE THE HONOR TO APPLY FOR A PERMIT TO DEMOLISH A ________________________ BUILDING / STRUCTURE, LOCATED AT _____________________________________________________ SHOWN IN THE SKETCH AT THE BACK OF THE FORM. IN THIS CONNECTION, I CERTIFY TO THE FOLLOWING: 1. THE UNDERSIGNED IS THE BONAFIDE OWNER (AUTHORIZED REPRESENTATIVE) OF THE BUILDING / STRUCTURE TO THE DEMOLISHED. 2. THE BUILDING / STRUCTURE IS NOT LEASED TO ANY OTHER PARTY IS NOT INVOLVED IN ANY COURT LITIGATION. 3. THE SUBJECT BUILDING / STRUCTURE IS ALREADY VACATED AND ALL UTILITY LINES SUCH AS WATER, ELECTRIC, GAS AND TELEPHONE HAVE ALREADY BEEN DISCONNECTED. 4. THE REAL ESTATE TAX OF SUBJECT BUILDING / STRUCTURE HAS BEEN PAID FOR THE CURRENT YEAR AS PER HEREIN ATTACHED COPY OF THE RECEIPT. 5. THE PROPOSED DEMOLITION SHALL BE UNDERTAKEN UNDER THE DIRECT SUPERVISION OF _______________________________________________, A LICENSED ARCHITECT / CIVIL ENGINEER WHO SIGNIFIED HIS/HER ACCEPTANCE OF THIS RESPONSIBILITY BY AFFIXING HIS/HER SIGNATURE AND SEAL HEREUNDER. _____________________________________ ARCHITECT/CIVIL ENGINEER

_________________________________________ OWNER/AUTHORIZED REPRESENTATIVE

PRC REG. NO. ________________________ PTR NO. _____________________________ DATE ISSUED _______________________ PLACE ISSUED ______________________ _____________________________________

TIN _____________________________________ ADDRESS _______________________________ ________________________________________

CONFORME: ____________________________ LOT OWNER _________________ TIN _________________________________________________________________________________________ _REPUBLIC OF THE PHILIPPINES) _____________________________ ) S.S. BEFORE ME, A NOTARY PUBLIC IN AND FOR THE _____________________________________ PHILIPPINES THIS TO ME AS THE PERSON WHO EXPECTED THE FOREGOING INSTRUMENT AND HE/SHE ACKNOWLEDGE TO ME THAT SAME IS HIS/HER FREE AND VOLUNTARY ACT AS DEE. IN WITNESS HEREOF, I HAVE HEREUNTO AFFIXED MY HAND AND NOTARIAL SEAL ON THE DATE AND PLACE ABOVE STATED. SUBSCRIBED AND SWORN TO BEFORE ME this ______ day of ________________, 200___ at Lucena City. ____________________________________ Book No. ___________ Page No. ___________ Doc. No. ___________ Series of ____________

NOTARY PUBLIC UNTIL _____________________________ ON ________________________________ T __________________________________