LOCAL GOVERNMENT OF SAN MATEO, RIZAL

Municipal Engineering Office

APPLICATION FOR SIGN PERMIT

Application Number Sign Permit Number Building Permit Number Date of Application
ONL-
BOX 1 (TO BE ACCOMPLISHED IN PRINT BY THE SUPPLIER/APPLICANT AND BY THE STRUCTURAL DESIGN PROFESSIONAL)

LAST NAME

FIRST NAME
OWNER /
APPLICANT
MIDDLE NAME

TIN NO. - - -
ENTERPRISE NAME
FOR CONSTRUCTION OWNED
BY AN ENTERPRISE
FORM OF OWNERSHIP

MANNER OF OCCUPANCY AS STATED IN BUILDING PERMIT

ADDRESS NO. STREET BARANGAY CITY / MUNICIPALITY ZIP CODE

CONTACT DETAILS TEL NO. MOBILE NO.

BASE BUILDING LOT NO. BLOCK NO. STREET

LOCATION OF
CONSTRUCTION BARANGAY (IN SAN MATEO) TCT NO. TAX DEC. NO.

SCOPE OF WORK
New Construction
Erection ___________________________
Addition ___________________________
Alteration __________________________
Renovation _________________________ Demolition ________________________
Conversion _________________________ Accessory Building / Structure
Repair ______________________________ ____________________________________
Moving _____________________________ Others _____________________________

USE OR CHARACTER OF SIGN

A. TYPE OF DISPLAY

Neon Double Face Multimedia

Single Face Painted on Other __________________________
Illuminated

B. TYPE OF INSTALLATION

Business Sign, Wall Type Business Sign, Temporary Advertising Sign, Wall Type
Business Sign, Projecting Type Advertising Sign, Ground Type Advertising Sign, Other
Business Sign, Ground Type

C. Area / Dimension

L (m) = __________________________ W (m) = __________________________ At (m2) = __________________________

BOX 2 (TO BE CHECKED, RECEIVED, AND RECORDED)

ACCOMPANYING DOCUMENTS (5 SETS EACH, SIGNED AND SEALED BY RESPONSIBLE DESIGN PROFESSIONAL)
CERTIFIED COPY OF TCT PHOTOCPY OF LOT PLAN AND SITE DEVELOPMENT PLAN
IF NOT OWNED BY THE APPLICANT IN ADDITION TO THE PLANS OF SIGN STRUCTURES, STRUCTURAL
CERTIFIED PHOTOCOPY, PHOTOCOPY OF CONTRACT OF LEASE DESIGN & COMPUTATIONS
PHOTOCOPY OF TAX DECLARATION AND LATEST SPECIFICATIONS AND COST ESTIMATES
REALTY TAX RECEIPT

BOX 3 DESIGN PROFESSIONAL, PLANS, AND SPECIFICATIONS BOX 4 FULL-TIME INSPECTOR AND SUPERVISOR OF CONSTRUCTION WORKS

____________________________________________ ____________________________________________
ARCHITECT OR CIVIL ENGINEER (Signature Over Printed Name) ARCHITECT OR CIVIL ENGINEER (Signature Over Printed Name)

Date ______________________________ Date ______________________________

ADDRESS ADDRESS

PRC NO. VALIDITY PRC NO. VALIDITY

PTR NO. DATE ISSUED PTR NO. DATE ISSUED

ISSUED AT TIN NO. ISSUED AT TIN NO.

SMR-MEO-F-0008-2017 Page 1 of 2
 APPLICATION FOR SIGN PERMIT
BOX 5 APPLICANT

____________________________________________
APPLICANT (Signature Over Printed Name)

Date ______________________________

ADDRESS

CTC NO. DATE ISSUED

PLACE ISSUED TIN

BOX 6 BUILDING OWNER BOX 7 WITH MY CONSENT: LOT OWNER

____________________________________________ ____________________________________________
(Signature Over Printed Name) (Signature Over Printed Name)

Date ______________________________ Date ______________________________

ADDRESS ADDRESS

CTC NO. DATE ISSUED CTC NO. DATE ISSUED

PLACE ISSUED TIN NO. PLACE ISSUED TIN NO.

BOX 8 (TO BE ACCOMPLISHED BY THE PROCESSING AND EVALUATION DIVISION)

Fee Paid ____________________ Date Paid ______________________ Official Receipt No.______________ Date Issued ____________________

SMR-MEO-F-0008-2017 Page 2 of 2