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__________________________
DISTRICT/CITY/MUNICIPALITY
AREA CODE
APPLICATION NO. PERMIT NO.
APPLICATION FOR
ELECTRICAL PERMIT
_________________________________ ______________________________
DATE OF APPLICATION DATE ISSUED
BOX 1 (TO BE ACCOMPLISHED BY PROFESSIONAL ELECTRICAL ENGINEER/MASTER ELECTRICIAN, IN PRINT)
NAME OF OWNER/APPLICANT LASTNAME, FIRST NAME, M.I. TIN
OF COMPLETION __________________________________________
WE HEREBY AFFIX OUR HANDS SIGNIFYING OUR CONFORMITY TO THE INFORMATION HEREIN ABOVE SETFORTH
BOX 3 (Person who signed and sealed plans & specifications) BOX (PERSON IN-CHARGE OF THE INSTALLATIONS)
ELECTRICAL ENGINEER/ P.R.C REG. No.
ELECTRICAL ENGINEER/ P.R.C. REG. No. MASTER ELECTRICIAN
MASTER ELECTRICIAN
PRINT NAME PRINT NAME
ADDRESS
ADDRESS
P.T.R. No. DATE ISSUED PLACE ISSUED P.T.R. No. DATE ISSUED PLACE ISSUED
SIGNATURE TIN
SIGNARURE TIN
BOX 4
SIGNATURE OWNER TIN RES. CERT NO. DATE ISSUED PLACE ISSUED
ELECTRICAL PERMIT
NAME OF OWNER/APPLICANT LAST NAME, FIRST NAME, M.I. TAXPAYER’S IDENTIFICATION NO.
PROGRESS FLOW
NOTE: IN OUT
CHIEF, PROCESSIUNG DIVISION/SECTION TIME DATE TIME DATE ACTION \/REMARKS PROCESS BY
ELECTRICAL
REVIEWED
NOTE:
THIS PERMIT MAY BE CANCELLED OR REVOKED PURSUANT TO SECTIONS 305 &306 OF THE “NATIONAL BUILDING CODE”