OFFICIAL GAZETTE

Annexed Form No. 4
Form No. 4 Original (B 5)
(Original) Application for Confirmation (Structure)
(Note) Before filling in, read note in bottom of sheet for copy •E^Column for fee
I hereby submit application for confirmation in accordance with
Article 88 paragraph 1 of the Building Standard Law.
I certify that matters and facts given in this application and
in annexed drawings and documents are true and nothing but
true.'
Name of Applicant
(Seal)
o
1. Name and address of
owner
2. Name and address of
agent
3. Oiialifimtinn nf rlPiRiVnp.r
and his name and ad- | Class Architect Registration No.
dress !
4. Name of contractor or
builder and his address
(Tel.)
(Tel.)
(Tel.)
Construction Contractor, Registration No. (Tel.)
5. Name of place of site
and No.
6. When expect to start
work
Date :
7. When expect to
complete work
Date :
8. Remarks
a) Kind of structure
b) Height of
structure
o
9. Brief
description
of
St ructure
c) Construction
of structure
d) Scope of
structure
^•EColumn for receiving •E^Column for decision •E^•EColumn for confirmation No.
Date : Date :
No.
Signed by : official in charge
(Seal)
No.
Signed by: official in charge
(Seal)
44-