272194 (RPL)BUILDING PERMIT
DEPARTMENT OF BUILDING & SAFETY
. COUNTY OF RIVERSIDE
CONSTRUCTION ESTIMATE. '`, NO. ELECTRICAL FEES
ST FL.. SQ.FT. @ UNITS
2ND FL. - SO. FT. @
POR. SO. FT. @ MOBILEHOME SVC.
GAR. SQ. FT. @ POWER OUTLET
CAR P. ISO.FT. @
,,WALL SO. FT. @ j
EST MATED CONSTRUCTION VALUATION $ {I�j
NOTE: Not to be used as property tax valuation
MECHANICAL FEES
VENT SYSTEM ❑ FAN ❑ EVAP..000L ❑ HOOD
SWIM POOL, PVT
SWIM POOL, COMM
SIGN
FIELD OFFICE
NO. PLUMBING FEES
YARD SPKLR SYSTEM
BAR SINKt
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN'
URINAL t,
WATER PIPING
,l FLOOR DRAIN
WATER SOFTENER
WASHER (AUTO) IDISHI
DST
APPLIANCE
JOB ADDRESS SP NO OWNER
74
r
C?I '^R,r fiii [r ,d A � '. � r" -, ;� ' !' % I "1 -
GARBAGE DISPOSAL
.ht! i cl r . .i j•
USE OF PERMI
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR- ❑ SUSPENDED
F.C. DAT PE I O.
76
LAUNDRY TRAY
M H PERMIT FEE
AIR HANDLING UNIT
CFM
IDLE METER
COMMUNITY
KITCHEN SINK
UNITS
ABSORPTION SYSTEM
0 B.T.U.
TEMP USE PERMSVC
WATER CLOSET
COMPRESSOR
HP
POLE, TEMP/PERM
LAVATORY
[VALUATION
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
AMPERES SERV ENT
SHOWER
BOILER � B.T.U.
SQ FT @ a
BATH TUB
MICROFILM FEE
COPIES
SQ FT @ ¢
WATER HEATER
SQ FT RESID @ 1¢
C, r
SEWAGE DISPOSAL
DBL
$
SQ FT GARAGE @ 'h¢
LOT SIZE ZONE
HOUSE SEWER
USE NO.
PERMIT FEE
TYPE
BY
GAS PIPING
MOBILE HOME PERMIT FEE
Is
PERMIT FEE
PERMIT FEE
<-.► Q('
IR IT O. 9
TOTAL FEE -
MOB. HM.FEE
MICRO FEE
MECH. FEE
DBL.
PL. CK. FEE
CONST. FEE
DBL.
ELECT. FEE
DBL.
SMI FEE
FEE
PLUMEE DBL.
J F M A M J J A S O N D
JOB ADDRESS SP NO OWNER
74
r
C?I '^R,r fiii [r ,d A � '. � r" -, ;� ' !' % I "1 -
.ht! i cl r . .i j•
USE OF PERMI
75
F.C. DAT PE I O.
76
�' -� 272194
M H PERMIT FEE
$
COMMUNITY
/"DST
UNITS
ROOMS
SUPP. TO PERMIT OFFICE
[VALUATION
MICROFILM FEE
COPIES
$
LEGAL DESCRIPTION
d j_Y.
FJ55,711
C, r
MECHANICAL FEE
DBL
$
SEtTy BACK
LOT SIZE ZONE
USE NO.
GRP
TYPE
BY
ICK
U
/7
A
PLAN CHECK FEE
$
BOND AMT. Or
PLAN NO.
PLAN CHECKER
FINAL DATE
INSPECTOR
/6'
16-119
-
6 -q i b
e -(EA
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER INVOL ED
0
{l 0
_
-;
ELECTRICAL FEE
DBL
$
ADDRESS
CITY
STATE
%
STRONG MOTION
$
OWNER/AGENT'S SIGNATURE
CONJ!�ACTOR ! ��✓ �` - "
INSTRUMENTATION FEE
/
�a`!�-�� l +rf t ✓ ..
$
ADDRESS
ADDRESS r
FEE
PLUMBING FEE
DBL
$
CITY ZIP CODE
CITY / ZIP CODE
TOTAL FEES
TEL. NO.
TEL. NO. LICENSE
} % /
CASH ❑ CHECK Q M.O. ❑ N.C. ❑
A,6THISPERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSA
N OF WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
RECEIVED BY ���
TREES REQUIRED
I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN AC
CORDANCE WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSC
SEWAGE SYSTEMJ
LLL
T
P !ti
AGREE TO CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLIANCE WITH THE
I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS
FORM 284208 (Rev. 10-74) @L HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE
OF THE STATE OF CALIFORNIA.