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REPUBLIC OF THE PHILIPPINES PROVINCE OF PAMPANGA CITY OF SAN FERNANDO OFFICE OF THE BUILDING OFFICIAL AREA CODE 5416W NBC FORM NO. A-04 MECHANICAL PERMIT APPLICATION NO. DATE OF APPLICATION DATE ISSUED BOX 1 TO BE ACCOMPLISHED IN PRINT BY THE APPLICANT OWNER/APPLICANT LAST NAME FOR CONSTRUCTION OWNED BY AN ENTERPRISE ADDRESS NO. REPUBLIC OF THE PHILIPPINES PROVINCE OF PAMPANGA CITY OF SAN FERNANDO OFFICE OF THE BUILDING OFFICIAL AREA CODE 5416W NBC FORM NO. A-04 MECHANICAL PERMIT APPLICATION NO. DATE OF APPLICATION DATE ISSUED BOX 1 TO BE ACCOMPLISHED IN PRINT BY THE APPLICANT OWNER/APPLICANT LAST NAME FOR CONSTRUCTION OWNED BY AN ENTERPRISE ADDRESS NO. M. I FORM OF OWNERSHIP STREET LOCATION OF CONSTRUCTION STREET FIRST NAME B ARANGAY USE ORCHARACTER OF OCCUPANCY CITY/MUNICIPALITY LOT NO. BARANGAY SCOPE OF WORK NEW CONSTRUCTION ERECTION ADDITION ALTERATION TIN ZIP CODE TELEPHONE NO. TAX DEC. NO. RENOVATION CONVERSION REPAIR MOVING RAISING DEMOLITION ACCESSORY BUILDING/STRUCTURE OTHERS Specify INSTALLATION AND OPERATION OF BOILER PRESSURE VESSEL INTERNAL COMBUSTION ENGINE REFRIGERATION AND ICE MAKING WINDOW TYPE AIRCONDITIONING PACKAGED/SPLIT TYPE AIRCON CENTRAL AIRCONDITIONING MECHANICAL VENTILLATION ESCALATOR MOVING SIDEWALK FREIGHT ELEVATOR PASSENGER ELEVATOR CABLE CAR DUBMWATER PUMPS COMPRESSED AIR VACUUM INSTITJUTIONAL and/or INDUSTRIAL GAS PNEUMATIC TUBES CONVEYORS and/or MONORAILS FUNICULAR PREPARED BY BOX 3 BOX 4 DESIGN PROFESSIONAL PLANS AND SPECIFICATIONS SUPERVISOR / IN-CHARGE OF MECHANICAL WORKS PROFESSIONAL MECHANICAL ENGINEER MECHANICAL ENGINEER Signed and Sealed Over Printed Name Date PRC. No* Validity PTR* No* Date Issued Issued at BUILDING OWNER WITH MY CONSENT LOT OWNER Signature Over Printed Name C. T. C No* Place Issued http //www. cityofsanfernando. gov*ph TO BE ACCOMPLISHED BY THE PROCESSING AND EVALUATION DIVISION BOX 7 DATE RECEIVED BY FIVE 5 SETS OF MECHANICAL DOCUMENTS MECHANICAL PLANS AND SPECIFICATIONS COST ESTIMATES BILL OF MATERIALS BOX 8 PROGRESS FLOW IN OUT TIME PROCESSED BY RECEIVING AND RECORDING MECHANICAL BOX 9 ACTION TAKEN PERMIT IS HEREBY ISSUED SUBJECT TO THE FOLLOWING That the proposed mechanical works shall be in accordance with the mechanical plans filed with this Office and in conformity with the latest Philippine Mechanical Code the National Building Code and its IRR* That prior to any mechanical installation a duly accomplished prescribed Notice of Construction shall be submitted to the Office of the Building Official* That upon completion of the Mechanical works the licensed supervisor / in-charged shall submit the entry to the logbook duly signed and sealed to the building official including as-built plans and other documents and shall also accomplished the Certificate of Completion stating that the mechanical works conform to the provision of the Philippine Mechanical Code the National Building Code and its IRR* That this permit is null and void unless accompanied by the building permit. That a Certificate shall be issued for the continuous use of installations. PERMIT ISSUED BY BUILDING OFFICIAL NOTE THIS PERMIT MAY BE CANCELLED OR REVOKED PURSUANT TO SECTIONS 305 AND 306 OF THE NATIONAL BUILDING CODE*.