I

Republic of the Philippines '

'
Department of the lnterior and Local Government
BUREAU OF FIRE PROTECTION

HRI SITITY IT$PTGIIOII GTRII]IGITT

(FOR BUSTNESS PERMTT)

TO WHOM IT MAY CONCERN:

I
By virtue olthe provisions of RA 9514 othenarise known as the Fire Code of:the Philippines of 2008, the application for
FIRE SAFETY INSPECIIOiI CERTIFICATE of .- __ . . .
(N ame ol Establishme nt)

6wned and managd by with'posial address at

{N arne of Own er/Rep res entativ e)

it h",,*by'GRANTED afrer said buiiding structure or faciiity has been duly inspected with ihe findings that it has fully cornplied wth the
fi.iesafe$andprotecti.onrequirementsoftheFireCodeofthePhilippinesof200BanditslmptementingRulesandReguIations'

This certificate is being issued for

Ihis sertification is valid:until

, Violation of Fir'6 Code provisiens shall rpso facfo cause ihis certificate null and void, and shall hoid the owner of the
building liable to the penatfes provided for by the said Fire code.

Fire Code Fees:

Amount Paidr RECOIIIMEND'APPROVAL :
0,R. Number:
Date:

APPROVED:

ITJOIE;."Iiis Cerfifcafe:doss noltakethe place'of any license required by taw an!:iq nottransiferabte. Any change in ffte use
. of occupancy of fie premrses :shall requira a new certiflcate:'

. THIS CERTIFICATE $HAIL BE POSTED CONSPICUOUSLY ],

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*FIRE SAFETY IS'OUR MATN CONCERN''
DISIRIBUTIOi{i .
' Wl Bl@+tw (Applicad/Awrlo/5 copy)
Pink(EPLO'S@W)
AtuePFP scog)

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