166971 (SFD)DEPARTMENT OF BUILDING & SAFETY
1
COUNTY OF RIVERSIDE
FIELD OFFICE
ILOT SIZE
#, A�
CONSTRUCTION ESTIMATE
JOB ADDRESS OWNS
6/— 6 iz
ELECTRICAL FEES
PLUMBING FEES
ISt FI.
2nd FI.
Por.
Gar. 2
Car P.
Wall
Sq. F}. @
?, NO.
NO.
I 1 f
Sq. Ft. @
Sq. Ft. @
USE OF BUILDING J
Sq. Ft. @ 2-: POLES
PLAN CHECK FEE i b
Sq. Ft. @ .SIGNS ORAINAGE PIPING
Sq. Ft. @ OR ATSCLK.O/ DRINKING FOUNTAIN
Sq. Ft. @ MOTOR N.P. URINAL
CN CKED BY
MOTOR N.P. WATER PIPING
T
ESTIMATED VALUATION Is 1n
MOTOR
H.P.
FLOOR DRAIN
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MECHANICAL FEES
JIJISTR
MOTOR
H.P.
WATER SOFTENER
VENT SYSTEMFAN 11EVAP. COOL ❑ HOOD
'�
MOTOR
H.P.
WASHER (AUTO)
APPLIANCE
.
CONSTRUCTION FEE
FIXTURES
GARBAGE DISPOSAL
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FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
OUTLETS
SPEC. INSP.
LAUNDRY TRAY
SUPP. TO PERMIT
AIR HANDLING UNIT
SUB -PANEL
KITCHEN SINK
GAS PIPE 13 NATURAL ❑ L.P.G. 13 OIL
BOND $
BOND
�1
/.
WATER CLOSET
FINAL DATE
5'I •(D L1
COMPRESSOR HP
TOTAL FEES
RANGE AND/OR OVEN
"�
LAVATORY
%�C+
APPLIANCE VENT
PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED
WITHIN 60 DAYS. CESSATION OF WORK FOR 120 DAYS SHALL ALSO
CAUSE PERMIT TO BECOME VOID.
I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS
WATER HEATER
IECEIVED BY
SHOWER
ABSORPTION SYSTEM D B.T.U.
PERMIT WILL BE DONE IN ACCORDANCE WITH THE LAWS OF RIVER-
SPACE HEATER
BATH TUB
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INCINERATOR DOMESTIC ❑ INDUS. ❑ COMM.
CONSTRUCTION POLE
WATER HEATER
SIDE COUNTY AND THE STATE OF CALIFORNIA. I ALSO AGREE TO
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
SERVICE ENTRANCE t'
SEWAGE DISPOSAL
. BOILER B.T.U.
RryrM}ATION
RESID. IC SQ. FT.
HOUSE SEWER
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RESIDErTAL FEE 5fdie�r,�@
GARAGE zQ SQ. FT. �.
GAS PIPING
PERMIT FEE
PERMIT FEE
ADDRESS
PERMIT FEE
t1�
-ERMIT NU
E
66971
Nr01 L4017)-.-1.
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r:NI,DBL.
TOTAL FEES
AT ;M4.
PLN.K. FEE
CONST. TEE
ELEC. FEE
J
PLUMB. FEE
r.
J F M 1.q M
J A
S O
N D
LICENSE NO.
SET BACK
a.�
ILOT SIZE
#, A�
USE #
JOB ADDRESS OWNS
6/— 6 iz
- :/ -.
S
R
.�
I 1 f
ZONE
USE OF BUILDING J
PLAN CHECK FEE i b
�a r
]CVWMtTNI_Y`Y
2Vvto
CN CKED BY
T
P. X.
VALUATION
- E
MECHANICAL FEE +_/
•� 1�-, fy' i
JIJISTR
JUNITS
i
�,`,� . 7/
GROUP'
TYPE
L� A'L D� RTI
fi_
.
CONSTRUCTION FEE
9 i
�p
6M69IP
SPEC. INSP.
SUPP. TO PERMIT
j
ELECTRICAL FEE (}}t�
•'� :-4 . , _
PLUMBING FEE
PLAN CHECKER
BOND $
BOND
I C494
PLAN FILE it
FINAL DATE
5'I •(D L1
INSPECTOR
Culx_x
TOTAL FEES
$�
THIS
PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED
WITHIN 60 DAYS. CESSATION OF WORK FOR 120 DAYS SHALL ALSO
CAUSE PERMIT TO BECOME VOID.
I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS
CASH CHECK M. o. N.c.
IECEIVED BY
SEWAGE SYSTEM
PERMIT WILL BE DONE IN ACCORDANCE WITH THE LAWS OF RIVER-
EP
SIDE COUNTY AND THE STATE OF CALIFORNIA. I ALSO AGREE TO
T
LL
CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLI-
ANCE WITH LAWS OF THE STATE OF CALIFORNIA COVERING CON-
RryrM}ATION
TRACTORS
TRACTORS IS ALSO GUARANTEED.
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QW HEERR,s
CONTRACTOR
ADDRESS
ADDRESS
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Ty
7 2
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Nr01 L4017)-.-1.
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TEL. NO.
TEL. NO.
r.
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LICENSE NO.
I
!84-208 11/87
6
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