Republic of the Philippines
City of Lucena
OFFICE OF THE CITY MAYOR
Business Permits and Licensing Office
Telephone no. +63 42 710-8892
To be accomplished in three (3) copies
APPLICATION
New
Renewal
Date of Application in PBR (mm/dd/yyyy)
Date of Application in LGU (mm/dd/yyyy)
Reference No. / B.I.N.
DTI/SEC/CDA Registration No.
TIN
*Kind of Ownership
Sole Proprietorship
Partnership
SSS No.
Corporation
*Business Name
*Name of Applicant / Owner / Manager
(Surname, First name ,MI)
APPLICANTS/OWNERS/MANAGERS ADDRESS
BUSINESS ADDRESS
Check if same with business address
*House No./Bldg. No.
House No./Bldg. No.
*Street
Street
*Barangay
Barangay
Subdivision
Subdivision
City
LUCENA CITY
Province
QUEZON PROVINCE
Telephone No.
E-mail Address
City/Municipality
Province
Telephone No.
E-mail Address
*Business Area (in sq m)
*No. of Employees
*No. of Owners
Professional
OWNED
RENTED
Non-Professional
If place of business is RENTED, please identify the following
Lessors Name
Monthly Rental
LESSORS ADDRESS
House No./Bldg. No.
Subdivision
Street
City/Municipality
Barangay
Telephone No.
Province
E-mail Address
Property Index Number (P.I.N.) Real Property Information
Land
Building
Machinery
BUSINESS ACTIVITY(ies) (Attach additional page if necessary)
Line of Business
Capitalization
Gross Sales/Receipts
*Mode of Payment
Annual/Full
Quarterly
No. of Quarters
I hereby declare under the penalty of perjury that the above
information are true and correct and that any misrepresentation on
this application will be a ground for the revocation of my Business
and Mayors Permit.
SIGNATURE OF APPLICANT
POSITION / TITLE
SUBSCRIBE AND SWORN before me this _________day of _____________________ 20 _____ at
the CITY/MUNICIPALITY of _____________________ affiant exhibited to me his/her residence certificate No.
A________________ issued at ____________________________ on ________________________.
Doc No.____________
Page No.___________
Book No. ___________
ADMINISTERING OFFICER
Series of 20____
* Required fields (Mangyari pong sagutan ang lahat na hinihingi at kailangang impormasyon)
Page 1 of 2
Received by:
Date:
Time:
Please complete all required information to help us assess your business accurately and quickly.
Kumpletuhin ang impormasyon para sa mabilis na proseso at tamang pagtasa ng inyong aplikasyon.
Does your business has a delivery van or truck?
Yes
No
If, YES
no. of unit(s)
Does your business has a weights & measures timbangan o panukat?
Yes
If, YES
no. of unit(s)
max. capacity
kilograms
no. of unit(s)
max. capacity
Liters
no. of unit(s)
max. capacity
meters
Retailer (Sari-Sari Store etc.)/Dealer/Wholesaler
(Please check if available)
Cigarettes/Tobaccos
Distilled wines
Tuba, Basi and /or Tapuy and vine
Domestic/Fermented Liquor/Beers
Foreign Liquor
Computer Shop/Internet Caf/PC Gaming Caf
Bakeries/Bakeshop
Barber Shops/ Beauty Parlors
Blue printing/Photocopy Centers/Printing
Shops/Printing Press/Photo Shops/ Tailoring
Shop/Dress Shops/Embroidery Shops
Private Hospitals/Clinics
PC unit(s)
oven(s)
chair(s)
machine(s)
bed(s)
Amusement Places/Business
Theaters/Cinema with or without Balcony
Therapeutic Clinics/Sauna bath
Mahjong/Casino
Billiard/Pool Center
Bowling Center
seat(s) Air-conditioned
Yes
cubicle(s)
table(s)
billiard/pools table(s)
automatic lane(s)
non-automatic lane(s)
videoke/jukebox/machine(s)
game machine(s)
Amusement devices/machines
Trucking Business
Transportation Business
Storage of Flammable/Combustible Materials
Gasoline/Diesel/Regular/Kerosene/Coconut
Oil/LPG and other similar products
Calcium Carbide
Tar/Resin and similar products
Coal Deposits
Others (Pls. specify)
LOCATIONAL SKETCH
Main Road/Street
Corner Street
Secondary Road/Street
No
No
truck(s)
air-conditioned bus(es)/van(s)
non air-conditioned bus(es)/van(s)
Maximum Capacity
liters
cases
kilograms
tons
ENDORSEMENTS
CLEARANCES
Barangay
Business
Clearance
OFFICE/AGENCY &
ADDRESS
Barangay where
business is located
Zoning
Clearance
City Zoning Office
Sanitary/Health
Clearance
City Heath Office
City
Engineering
Clearance
REMARKS
Old City Hall Bldg. near
Police Station
near Quezon Memorial
Hospital
City Engineering Office
Dalahican Road, a
kilometer away from SM
Lucena.
Fire Safety
Clearance
City Fire Department
Land Tax
Clearance
Land Tax Division
PNR Compound at the
back of Perez Park
City Treasurers Office,
Old City Hall Building
Page 2 of 2
CITY OF LUCENA
BUSINESS PERMIT & LICENSING OFFICE
Requirements for
RENEWAL OF APPLICATION:
To be attached
1. Application Form (complete * Required Fields w/ locational sketch)
2. Community Tax Certificate
3. Receipt of Last Years Payment
4. Barangay Business Clearance
5. Lease Contract
6. DTI/SEC Registration
7. National Agency Accreditation (if applicable)
8. Last Years Application Form
9. Market Clearance (for Market Vendors)
10. Homeowners Clearance (if applicable)
11. Clearances from Zoning Office, Engineering Office, City Health Office, City Fire
Department and Land Tax Division
NEW APPLICATION:
To be attached
1. Application Form (complete * Required Fields w/ locational sketch)
2. Community Tax Certificate
3. Barangay Business Clearance
4. Lease Contract
5. DTI/SEC Registration
6. Clearances from Zoning Office, Engineering Office, City Health Office, City Fire
Department and Land Tax Division
7. If applicable:
National Agency Accreditation
Market Clearance (for Market Vendors)
Homeowners Clearance
8. Renovation/Building Permit
REMINDER!
Renewal Period Without Penalty
January 1 30
Quarterly Period Without Penalty
2nd Quarter April 1 30
3rd Quarter July 1 30
4th Quarter October 1 - 30
