BLCK (173185)DEPARTMENT OF BUILDING & SAFETY
"SET BACK LOT S12E
COUNTY OF RIVERSIDE
USE R
FIELD OFFICE
CONSTRUCTION ESTIMATE
ELECTRICAL FEES
PLUMBING FEES
1st FI.
2nd F I.
Par.
Gar.
Car P.
Wall
Sq. Ft. @
NO.
NO.
Sq. Ft. @
Sq. Ft. @
USE OF S ILDING DATE
Sq. Ft. @ POLES
Sq. Ft. @ SIGNS
DRAINAGE PIPING
Sq. Ft. 10 ORATSCLK AND/
DRINKING FOUNTAIN
Sq. Ft. @ MOTOR M.P.
C
URINAL
MOTOR H.P.
WATER PIPING
ESTIMATED VALUATION $ " r, Pis MOTOR
H.P.
FLOOR DRAIN
MECHANICAL FEES
MOTOR
H.P.
WATER SOFTENER
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD
MOTOR
M.P.
WASHER (AUTO) (DISH)
APPLIANCE
FIXTURES
GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
OUTLETS
LAUNDRY TRAY
AIR HANDLING UNIT
SUB-PAMEL
N_UM
KITCHEN SINK
GAS PIPE ❑ NATURAL ❑ L.P.G. ❑ OIL
D{E
-- •-,
WATER CLOSET
COMPRESSOR D HP
RANGE AND/OR OVEN
CONSTRUCTION FEE
LAVATORY
APPLIANCE VENT
WATER HEATER
SHOWER
ABSORPTION SYSTEM D B. U.
SPACE HEATER
BATH TUB
INCINERATOR DOMESTIC ❑ INDUS. ❑ COMM.
CONSTRUCTION POLE
ELECTRICAL FEE
WATER HEATER
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
SERVICE ENTRANCE
SEWAGE DISPOSAL
BOILER :] B.T.U.
RESID. 11 SO. FT.
BOND
HOUSE SEWER
SO.FT. e
GARAGE JO 50. FT.
FINAL DATE
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
HERMIT NuT731
85
REN.
JDBL.
TOTAL FEES
HEAT & VENT FEE
PLN. CK. FEE
CONST. 'FEE
ELEC. FEE
PLUMB. FEE
F I AM J J A
I. F
S
10 IN D
"SET BACK LOT S12E
USE R
JOB ADDRESS OW NE
I
S R
c
ZONE
USE OF S ILDING DATE
PLAN CHECK FEE
j
r }
IIV
tC fJ
CHECKED BY
COM MUNI
DISTRICTF.C.
UNITS
VALUATION
OF .CE
MECHANICAL FEE
j
I
GROUP
GROUP YPE
LEGAL 1 ON
N_UM
BE
D{E
-- •-,
1PF`MIT
77 3318
CONSTRUCTION FEE
r ,- n _ r
SPEC. INSP.
SUPP. TO PERMIT
ELECTRICAL FEE
• '7_
PLAN CHECKER
BOND
BOND
CA
LA A FfICE V
FINAL DATE
INSPECTOR
PLUMBING FEE
_ .,/n C
,
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.
ECEIVED BY
SEWAGE
SYSTEM
PERMIT WILL BE DONE IN ACCORDANCE WITH THE LAWS OF RIVER-
a
SIDE COUNTY AND THE STATE OF CALIFORNIA. 1 ALSO AGREE TO
T
LL
P
CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLI-
ANCE WITH LAWS OF THE STATE OF CALIFORNIA COVERING CON -
"0
INFORMATION
TRACTORS IS ALSO GUARANTEED.
NOW OP CWSTOCTION
rMDER
OWNER,J
l
CONTRACTOR
MOM wrycv.
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ADTSS..j
-
ADDRESS
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TEL.NO. '
TEL. NO.
LICENSE Nd.
84-208 11/87
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