Sanitary Permit
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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)
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)
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