180975 (CONR)FIELD OFFICE
PLUMBING FEES
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
WATER'SOFTENER
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD
MOTOR
DEPARTMENT OF BUILDING & SAFETY
0 COUNTY OF RIVERSIDE 0
LOT SIZE
CONSTRUCTION ESTIMATE
ELECTRICAL FEES
1st FI.
2nd FI.
Por.
Gar.
Car P.
Wall
i
APPLIANCE
Sq. Ft. @
-*,/-
ND.
Sq. Ft. @
Sq. Ft. @
t
Sq. Ft. @
POLES
Sq. Ft. @
SIGNS
Sq. Ft. @
TRANS. AND/
OR T. LK.
E
Sq. Ft. @
MOTOR H. P.
MOTOR H. P.
ESTIMATED VALUATION Is
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MOTOR H. P.
GAS PIPE ❑ NATURAL ❑ L.P.G. ❑ OIL
MECHANICAL FEES
MOTOR H. P.
FIELD OFFICE
PLUMBING FEES
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
WATER'SOFTENER
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD
MOTOR
H. P.
LOT SIZE
WASHER (AUTO) (DISH)
JOB ADDRESS OWNER
.i
APPLIANCE
FIXTURES
F�
5 U
GARBAGE DISPOSAL
17
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
OUTLETS
'
O
LAUNDRY TRAY
PLAN CHECK FEE $
AIR HANOLING UNIT
SUB -PANEL
KITCHEN SINK '
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DISTRICTF.C.
GAS PIPE ❑ NATURAL ❑ L.P.G. ❑ OIL
UNITS
VALUATION OFFICE
WATER CLOSET
COMPRESSOR OHP
RANGE AND/OR
OVEN
/
LAVATORY
3 V'
APPLIANCE VENT
WATER HEATER
SHOWER
ABSORPTION SYSTEM O B.T.U.
SPACE HEATER
LEGAL D SCRIPTION
BATH TUB
INCINERATOR DOMESTIC ❑ INDUS. ❑ COMM.
CONSTRUCTION
POLE
WATER HEATER
,
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
SERVICE ENTRANCE
SEWAGE DISPOSAL
-y
BOILER B.T.V.
Rg.-a.D. IC SQ.
FT.
Y
HOUSE SEWER
PERMIT FEE
GARAGE zQ SO.
FT.
SUPP. TO PERMIT
GAS PIPING
PERMIT FEE
ELECTRICAL FEE $
w�
PERMIT FEE.
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1i
PERMIT NUMBER REN. DBL. TOTAL FEES MEAT tk VENT FEE PLN. CK. FEE CONST, F ELEC. FEE IPLUMB. FEE
J
J F M A M J J A S O N D
f J F l e I I. I S -�
SET BACK
LOT SIZE
USE #
JOB ADDRESS OWNER
F�
5 U
R {/
17
' ^y
•
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O
USE OF B ILDING 1 DATE
PLAN CHECK FEE $
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CHECKED BY
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DISTRICTF.C.
UNITS
VALUATION OFFICE
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MECHANICAL FEE $
44 I
GRO
TYPE
LEGAL D SCRIPTION
PERMIT NUMBER
,
3
CONSTRUCTION FEE $
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uZ
SPEC. INSP.
SUPP. TO PERMIT
ELECTRICAL FEE $
PLAN CHECKER
BOND $
BOND
CASH
PLAN FILE #
FINAL DATE
INSPECTOR
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PLUMBING FEE $
•/�?d'
TOTAL FEES"`�
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THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED
V
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.
RECEIVED BY
SEWAGE SYSTEM
PERMIT WILL BE DONE IN ACCORDANCE WITH THE LAWS OF RIVER- i
f
SIDE COUNTY AND THE STATE OF CALIFORNIA. I ALSO AGREE TO
a/
T
0
LL
PS 0
CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLI- I
ANCE WITH LAWS OF THE STATE OF CALIFOR�A COVERING CON- w'
TRACTORS IS ALSO GUARANTEED..—i
NAME OF CONSTRUCTION
LENDER
OWNER
CONTRACTOR
i
BRANCH OFFICE
1 NaDRESS
N.lj ' L
< �,l .5...
ADDRESS
ADDRESS
CITY
STATE
-
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NO LENDER INVOLVED
INFORMATION
TEL. NO.
TEL. NO.
f
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LICENSE NO.
284-208 12 8
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