BLCK (272117)BUILDING PERMIT
DEPARTMENT OF BUILDING & SAFETY
COUNTY OF RIVERSIDE
CONSTRUCTION ESTIMATE NO. I ELECTRICAL FEES
1 ST Cl I UNITS
MOBILEHOME SVC.
POWER OUTLET
SWIM POOL, PVT
SWIM POOL. COMM
SIGN
FIELD OFFICE
NO. PLUMBING FEES
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
WATER SOFTENER
WASHER IAHT01 (DISH)
DST
APPLIANCE
JOB ADDRESS SP NO
2ND FL.
SO. FT. @
POR.
SO. FT. @
- GAR.
SQ. FT. @
CAR P.
SOFT. @
WALL
SQ. FT. @
0 B.T.U.
SQ. FT. @
ESTIMATED CONSTRUCTION VALUATION $
NOTE: Not to be used as property tax valuation
HP
MECHANICAL FEES
LAVATORY
VENT SYSTEM
❑ FAN ❑ EVAP. COOL ❑ HOOD
MOBILEHOME SVC.
POWER OUTLET
SWIM POOL, PVT
SWIM POOL. COMM
SIGN
FIELD OFFICE
NO. PLUMBING FEES
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
WATER SOFTENER
WASHER IAHT01 (DISH)
DST
APPLIANCE
JOB ADDRESS SP NO
GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
-GWNNEER^
LAUNDRY TRAY
AIR HANDLING UNIT
CFM
IDLE METER
KITCHEN SINK
ABSORPTION SYSTEM
0 B.T.U.
TEMP USE PERM SVC
WATER CLOSET
COMPRESSOR
HP
POLE, TEMP/PERM
LAVATORY
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
AMPERES SERV ENT
SHOWER
BOILER � B.T.U.
ROOMS
SQ FT @ a
BATH TUB
OFFICE
SQ FT @ ¢
WATER HEATER
SQ FT RESID @ 1 ¢
SEWAGE DISPOSAL
ISUPP.
SQ FT GARAGE @ 'hrt
HOUSE SEWER
PERMIT FEE
COPIES
$
GAS PIPING
MOBILE HOME PERMIT FEE
$
PERMIT FEE
PERMIT FEE
E IT NO.
2 117
TOTAL FEES
MOB. HM.FEE
MICRO FEE
MECH. FEE
DBL.
PL. CK. FEE
CONST. FEE
--
DBL.
ELECT. FEE
DBL.
SMI FEE
FEE
PLUMB. FEE
DBL.
J I F I M A I M I J I J A I S 1 Q 1 N I D
JOB ADDRESS SP NO
74
-GWNNEER^
75
USE OF PERMIT
F, C.
DATE
76 -
-�� � 6" 1 s- x �.
r a �lY72117
M H PERMIT FEE
$
COMMUNITY
DST+
UNITS
ROOMS
VALUATION
TO PERMIT
OFFICE
ISUPP.
I
MICROFILM FEE
COPIES
$
LEGAL DESCRIPTION
t 777.3- 0�0��`�/i`T'j<
MECHANICAL FEE
DBL
$
SET BACK
LOT SIZE ZONE
USE NO.
GRP
TYPE
BY
T/
I
ICK
+���
F S R
!
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE
INSPEC OR
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER INVO VED
ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE
STRONG MOTION
$
OWNER/AGENT'S SIGNATURE
CONTRACTOR
INSTRUMENTATION FEE
�^arr ! 1' -1
•�/�
$
ADDRESS �/
ADDRESS
FEE
/
PLUMBING FEE
DBL
$
CITY ZIP CODE
CITY ZIP CODE
j t_/rrd
TOTAL FEES �
$ _
�
��
TEL. NO.
��� ,.. �f+•'�/`y �--
TEL. NO. LICENSE
CASH Ej CHECK ❑ M.O. O N.C. ❑
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSA
f LON OF WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
RECEIVED BY//5�
TREES REQUIRED
4
1 HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN AC
CORDANCE WITH THE
.1
SEWAGE SYSTEM
�t
LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSC
T
LL
P ��N
AGREE TO CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLIANCE WITH THI
I I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPAREDTHEPLANS AND SPECIFICATIONS
FORM 284-208 (Rev. 10-74) @L HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE
I OF THE STATE OF CALIFORNIA.