1. MPW FORM NO. 77-009-B
Republic of the Philippines
Province of Bohol
OFFICE OF THE BUILDING OFFICIAL
APPLICATION NO. ______________________________________ PERMIT NO.
__________________ DISTRICT /CITY/MUNICIPALITY _____________________
AREA CODE__________________
______________________ FENCING PERMIT __________________
DATE OF APPLICATION DATE ISSUED
BOX 1: (TO BE ACCOMPLISHED BY APPLICANT IN PRINT)
LAST NAME FIRST NAME MI TAX ACCT. NO.
NAME OF APPLICANT
FOR CONSTRUCTION OWNED
BY AN ENTERPRISE
FORM OF OWNERSHIP
ADDRESS NO. STREET BARANGAY CITY /MUNICIPALITY TEL NO.
LOCATION OF AREA NO. STREET BARANGAY CITY /MUNICIPALITY TEL NO.
TO BE FENCED
SCOPE OF WORK ( ) ADDITION ( ) RENOVATION
( ) NEW FENCE ( ) REPAIR ( ) OTHER (SPECIFY)
BOX 2: (TO BE ACCOMPLISHED BY THE RECEIVING & RECORDING SECTION )
ACCOMPANYING DOCUMENTS:
( ) XEROX COPY OF T.C.T.
( ) XEROX COPY OF LOT/SITE PLAN
( ) XEROX COPY OF LATEST LAND TAX RECEIPT
( ) XEROX COPY OF CONTRACT OF LEASE (IF NOT OWNED BY APPLICANT)
( ) OTHERS CLEARANCES (SPECIFY)
BOX 3: (TO BE ACCOMPLISHED BY DESIGNING ARCHITECT/CIVIL ENGINEER/CONTRACTOR IN PRINT)
LENGTH IN METERS HEIGHT IN METERS
MEASUREMENTS
TYPE OF FENCING ( ) INDIGENOUS MATERIALS ( ) R.C. & INTERLINK/CYCLONE WIRE
( ) R.C. (REINFORCED CONCRETE) ( ) R.C. & STEEL MATTING
( ) R.C. & CONC. HOLLOW BLOCKS ( ) R.C. & BARBED WIRE & OTHER WIRE
( ) R.C. & BRICKS ( ) OTHERS (SPECIFY)
BOX 4 (TO BE ACCOMPLISHED BY THE BUILDING OFFICIAL)
ACTION TAKEN
PERMIT IS HEREBY GRANTED SUBJECT TO THE FOLLOWING CONDITIONS:
1. THAT THE PROPSED CONSTRUCTION/ADDITION/REPAIR/RENOVATION SHALL BE IN CONFORMITY WITH
NATIONAL BUILDING CODE (P.D. 1096) AND ITS CORRESPONDING IMPLEMENTING RULES AND
REGULATIONS.
2. THAT THE REQUIRED PERMIT SHALL BE OBSERVED.
_____________________________
BUIDING OFFICIAL
___________________________
DATE
NOTE:
THIS PERMIT MAY BE CANCELLED OR REVOKED PURSUANT TO SECTIONS 305 AND 306 OF THE
NATIONAL BUILDING CODE.

2. BOX 5 ( TO BE ACCOMPLISHED BY THE DIVISION CONCERNED)
ASSESSED FEES
AMOUNT DUE ASSESSED BY O.R. NUMBER DATE PAID
( ) LINE & GRADE
( ) FENCING
( ) ELECTRICAL (IF ANY)
REVIEWED :
CHIEF PROCESSING DIVSION
TOTAL
BOX 6 ( TO BE ACCOMPLISHED BY THE DIVISION/SECTION CONCERNED)
PROGRESS FLOW
NOTED:
CHIEF PROCESSING DIVISION
IN OUT ACTION
REMARKS
PROCESSE
D BYTIME DATE TIME DATE
RECEIVING/RECORDING
GEODETIC (LINE CONFORMITY)
STRUCTURAL
ELECTRICAL
CASHIER
WE HEREBY AFFIX OUR HANDS SIGNIFYING OUR CONFORMITY TO THE INFORMATION HEREIN ABOVE SET
FORTH.
BOX 7: BOX 9:
ARCHITECT / CIVIL ENGINEER
SIGNED & SEALED PLANS &
SPECIFICATIONS
PRC REG. NO. APPLICANT
PRINT NAME:
PRINT NAME SIGNATURE
ADDRESS RES. CERT.
NO.
DATE ISSUED PLACE OF
ISSUE
P.T.R. NO. DATE ISSUED PLACE OF ISSUE
SIGNATURE TAN
BOX 8 : BOX 10 :
ARCHITECT / CIVIL ENGINEER
IN CHARGE OF CONSTRUCTION
PRC REG. NO. CONSENT OF LAND OWNER
PRINT NAME OF LAND OWNER:
PRINT NAME: ADDRESS:
ADDRESS: OCT / TCT NO. TAX DECLARATION NO.
P.T.R. NO. DATE ISSUED PLACE OF ISSUE RES. CERT. NO. DATE ISSUED PLACE
ISSUED
SIGNATURE TAN SIGNATURE TAN