217769 (BLCK)BUILDING PERMIT
-
SIGN
DEPARTMENT OF BUILDING & SAFET
COUNTY OF RIVERSIDE
.
FIELD OFFICE
-
TRANSFORMER =K.W.
CONSTRUCTION ESTIMATE
ELECTRICAL FEES
PLUMBING FEES
1ST FL.
2ND FL.
POR.
GAR.
CAR P.
WALL
ti t:vokAit
AIR HANDLING UNITI CFM
SQ. FT. @
KITCHEN SINK
NO.
NO.
SQ. FT. @
COMPRESSOR HP
SQ. FT. @ MOTOR 1 OR LESS H.P.
LAVATORY
SQ. FT. @ MOTOR 5 OR LESS H.P.
AMPERES SERV. ENT.
SQ. FT. @ MOTOR 20 OR LESS H.P.
DRAINAGE PIPING
SQ. FT. @
DRINKING FOUNTAIN
SQ. FT. @
URINAL
OK.W.UNITS
WATER PIPING
ESTIMATED VALUATION is
SEWAGE DISPOSAL
BOILER E== B.T.U.
FLOOR DRAIN
HOUSE SEWER
MECHANICAL FEES
OF MIN. FEE
'
we�-co C/•1CTCAICO
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD
SIGN
WASHER (AUTO) (DISH)
APPLIANCE
TRANSFORMER =K.W.
GARBAGE DISPOSAL
FURNACE❑UNIT ❑WALL❑FLOOR ❑SUSPENDED'
OUTLETS'
LAUNDRY TRAY
AIR HANDLING UNITI CFM
FIXTURE OR SOCKET
KITCHEN SINK
GAS PIPE ❑ NATURAL'- ❑ L.P.G. ❑ OIL
CONST. SERV. ENTRANCE
WATER CLOSET
COMPRESSOR HP
POLE
LAVATORY
APPLIANCE VENT
AMPERES SERV. ENT.
SHOWER
ABSORPTION SYSTEM O B.T.U.
SQ. FT.@ q
BATH TUB
INCINERATOR Cl DOMESTIC ❑ INDUS. OR COMM.
SQ. FT.@ q'.
WATER HEATER
HEATING SYSTEM � FORCED ❑ GRAVITY
SQ. FT. RESID. @ 1 q
SEWAGE DISPOSAL
BOILER E== B.T.U.
SQ. FT. GAR AGE @ z q
HOUSE SEWER
PERMIT FEEBALANCE
OF MIN. FEE
GAS PIPING
MOBILEHOME HOOKUP FEE
I$ I I
I I IPERMIT FEE I I
I - I PERMIT FEE I I
PERMIT NUMBER
TOTAAL�_W
MOB, HOOK FEE
HEAT & VENT FEE
7
PL. CK. FEE
COyyNST. EE�DBL
ELEC. FEE
USE OF BUILDING
FEE
PLUMBING FEE
DBL
17769
I
I
JDBL�
30
7 6 9
JDBLJ
J
J F M I A M I
J J 'A S O
N D
JOB ADDRESS
& 0 %!+1 5
OWNER
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J#73
72
7
,
USE OF BUILDING
F.C.
DATE
PEG I�
"�
30
7 6 9
75
CDVMUNITY
a_
DST'"'"
UNITS�ROOMJVALUATIONoo
/57-S
ISUPP.TOPERMIT
OFFICE
76
j/Y&V jL7z
f
MOBILEHOME
HOOKUP FEE
$
LE/GAL DESCRIPTION
(G� _ '7✓2 f �17 � �1-
- 7
MECHANICAL FEE
DBL
$
SET BACK
LOT SIZE
ZONE
USE NO. .
GRP
[TYPE
I CK BY
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE INSPECTOR
'
CONSTRUCTION FEE
DBL
t�
NAME OF CONST. LENDER
BRANCH OFFICE
NO LENDER' INVOLVED
ELECTRICAL FEE
DBL
$
ADDRESS
CITY STATE
$
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.
FEE
. I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE
IN ACCORDANCE WITH THE LAWS OF RIVERSIDE COUNTY AND THE S ATE OF CALIF -
ORNIA. I ALSO'AGREE TO
DBL
PLUMBING FEE
CARRY -COMPENSATION INSUR NCE UP( j Y Efy4PLOYEES.
`TRACTORS
COMPLIANCE WITH THE LAWS OF THE STATE OF CALIFORA COVERIVG CO;
IS ALSO GUARANTEED.
I HEREBY CERTIFY THAT THE INDIVIDUAL WHpPRPARED E P S AND SPECIFI-
CATIONS HAS DONE SO IN ACCORDANCE WITH 10 554�1� F , ` BUSINESS AND
TOTAL FEES $
(j
��
�/
PROFESSIONS CODE OF THE STATE OF CALIFOR,`FA>Ti'd-�""^
CASH ❑ CHEC
M.O. ❑ N.C. ❑
OWNER 10
,GON' AC TO RSV✓
RBCQIVBd BY
-
ADDRESS � - �
ADDRESS
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P
CITY
CITY
L. NO.
TEL. NO. LICENSE