176755 (BLCK)DEPARTMENT OF BUILDING & SAFETY
PE
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD
MOTOR H. P.
COUNTY OF RIVERSIDE
•
FIELD OFFICE
GARBAGE DISPOSAL
CONSTRUCTION ESTIMATE
ELECTRICAL FEES
PLUMBING FEES
1st FI.
2nd FI.
Par.
Gar.
Car P.
Wali
'
Sq. Ft. @
NO.
NO.
Sq. Ft. @
RANGE AND/OR OVEN
Sq. Ft. @
APPLIANCE VENT
Sq. Ft. @ POLES
—j
1.
Sq. Ft. @ SIGNS
DRAINAGE PIPING
TRANS. AND/
Sq. Ft. @ OR T. CLK.
DRINKING FOUNTAIN '
Sq. Ft. @ MOTOR H. P.
URINAL
$ f '
MOTOR
(/ MOTOR
H. P.
H. P.
WATER PIPING
FLOOR DRAIN
ESTIMATED VALUATION
HOUSE SEWER
MECHANICAL FEES
MOTOR
H. P.
WATER'SOFTENER
PE
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD
MOTOR H. P.
WASHER (AUTO) (DISH)
APPLIANCE
FIXTURES
GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
OUTLETS
LAUNDRY TRAY
AIR HANDLING UNIT
SUB -PANEL
KITCHEN SINK
GAS PIPE ❑ NATURAL ❑ L.P.G. ❑ OIL
WATER CLOSET
COMPRESSOR CHP
RANGE AND/OR OVEN
LAVATORY
APPLIANCE VENT
WATER HEATER
SHOWER
ABSORPTION SYSTEM D B.T.U.
SPACE HEATER
BATH TUB
INCINERATOR DOMESTIC ❑ INDUS. ❑ COMM.
CONSTRUCTION POLE
WATER HEATER
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
SERVICE ENTRANCE
SEWAGE DISPOSAL
BOILER B.T.U.
RESID. 10 SO. FT.
HOUSE SEWER
PERMIT FEE
GARAGE JC SO. FT.
GAS PIPING
UNITS
PERMIT FEE
PERMIT FEE
NUMBER IREN, IDBL, TOTAL F11 IHEAT 8 VENT FEE IPLN. CK. FEE .79q
J I e I M I A I M I J
I ne
19
CONST. FEE JELrC.. FEE
�I
A S O N
MB. FEE
SET BACK
LOT SIZE
USE #
JOB ADDRESS OWNER
F
5
RDki
ZONE
LISE OT-BUI DING"'
DATE
F z of
PLAN CHECK FEE $
/1 % P
CHECKED BY
`OM NITY
61STRICT
F.C.
UNITS
VALUATION
OFFICE
I
J
I
MECHANICAL FEE $
t;
y"'r
O
TYPE
LEGAL SCR IPT ION
PERMIT
NUMBER
1767
CONSTRUCTION FEE $
SPEC. INSP.
-
SUPP. TO PERMIT
ELECTRICAL FEE $
PLAN CHECKER
BONDS
BOND
CASH
PLAN FILE #
FINAL DATE
IN3 ECTOR
PLUMBING FEE $
1
I
^ �-O--7cl
`
TOTAL FEES
r
$
_o,
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. 0. N.C.
RECEIVED BY
SEWAGE SYSTEM
PERMIT WILL BE DONE IN ACCORDANCE WITH THE LAWS OF RIVER-
SIDE COUNTY AND THE STATE OF CALIFORNIA. I ALSO AGREE TO
-
r
LL
P
CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLI-
ANCE WITH LAWS OF THE STATE OF CALIFORNIA COVERING CON-
NAME OF CONSTRUCTION
LENDER
TRACTORS IS ALSO GUARANTEED.
OWNER
CONTRACTOR I
BRANCH OFFICE
ADDRESS
AD RESS
A DRESS
CITY
STATE
e'�2„•
NO LENDER INVOLVED
INFORMATION
TEL. NO.'
TEL.-NO.
ry
LICENSE NO.
284-208 12/88