200242 (SATT)EPARTMENT OF BUILDING & SAFETY
COUNTY OF RIVERSIDE
FIEiD OFFICE
REN. TRAILER FEE HEAT &jVEN��FEE
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CONSTRUCTION ESTIMATE
ELECTRICAL FEES
ELEC. FES oeL.
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PLUMBING FEES
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I ST FL. �
2ND FL:
POR. �
GAR. c `
CAR P.
'• WALL
SQ. FT. @ e f NO.
SQ. FT. @
NO.
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SQ. FT. @ MOTOR I OR LESS H.P.
SQ.FT. @ % MOTOR 5 OR LESS H.P. ! a k -
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SQ. FT. @ MOTOR 20 OR LESS H.P. 'DRAINAGE PIPING
SQ.FT. @ DRINKING FOUNTAIN
SQ. FT. @ URINAL
O K.W. UNITS WATER PIPING
E
ESTIMATED VALUATION $ leoF
FLOOR DRAIN
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MECHANICAL FEES
SET RAC k�
WATER SOFTENER
LOT SIZE
IUSE #
VENT SYSTEM 2§ -FAN ❑ EVAP. COOL 8 HOOD 00
SIGN
WASHER (AUTOV(DISH)
0
APPLIANCEdy .p
FORMER (� K.W.
f
GARBAGE DISPOSAL
'
FURNACE ❑ UNIT ❑ WALL ❑ LOOR ❑ SUSPENDED
OUTLETS
LAUNDRY TRAY
USE OF BUILDING?DATE
r
AIR HANDLING UNIT CFM
FIXTURE OR SOCKET
`
KITCHEN SINK
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GAS PIPE ❑ NATURAL ❑ L.P.G. ❑ OIL
CONST. SERV. ENTRANCE
WATER CLOSET
COMMUNITY
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POLE
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LAVATORY
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APPLIANCE VENT
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ABSORPTION SYSTEM O B.T.U.
SQ. FT. @
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INCINERATOR ❑ DOMESTIC ❑ INDUS. OR COMM.
SQ_FT. @ Q
%
WATER HEATER
p�RmITMBER�
CONSTRUCTION FEE
HEATING SYSTEM' f$ FORCED ❑ GRAVITY
SQ. FT. RESID. @ 14 ,0
/
SEWAGE DISPOSAL
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BOILER B.T.U.
SQ. FT. GARAGE @ 11z4
HOUSE SEWER
PLAN CHECKER
PERMIT FEE
BALANCE OF MIN. FEE
GAS PIPING
$
TRAILER ISSUANCE FEE -PERMIT FEE f
PERMIT FEE 6-n
B
PERMIT FEE
ri
PER
TOTAL FEES �
REN. TRAILER FEE HEAT &jVEN��FEE
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PL. CK. FS�•� CONST. FEi
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oBL.
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SPEC. INSP. FEE
PLUMBING FEE
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SET RAC k�
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IUSE #
JOB ADDRESS .
OWNER
154,
ZONE
USE OF BUILDING?DATE
PLAN CHECK FEE
$
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CHECKED BY
COMMUNITY
r
DISTRICT
F. C.
VALUATION
OFFICE
MECHANICAL FEE
$
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JUN
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f
DBL
GR�1 DTYPE
LEGAL DESCRIPTION -
p�RmITMBER�
CONSTRUCTION FEE
$
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0
DBL
PLAN CHECKER
SUPP. TO PERMIT 4
$
ELECTRICAL FEE
DBL
BONo $ -
BOND
CASH
PLAN FILE I FINAL
DATE
INSPECTOR i
PLUMBING FEE+
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NAME OF CON STR UCTION LENDER
BRANCH OFFICE
LENDER
TRAILER PERMIT
ISSUANCE FEE
$
j,0
NV0 LVED ,
i
f r1W
ADDRESS
CITY
STATE•
FEE
�'
THIS PERMIT SHALL B OME VOID IF WORK IS NOT COMMENCED WITHIN 60 DAYS. CESSATION
TOTAL FEES-
$
OF WORK FOR 120 DAY HALL ALSO CAUSE PERMIT TO BECOME VOID" n
I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCOR-
CASH Q CHECK M.O. E] N.C.
DANCE WITH THE LAWS OF RIVERSIDE. coutATY AND T.H,E STATE OF CALIFORNIA. I ALSO AGREE TO
CARRY. COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLIANCE WITH THE LAWS OF THE STATE
RECEIVED BY SEWAGE SYSTEM
OF CALIFORNIA COVERING CONTRACTORS IS ALSO GUARANTEED.
T p7TlJ LL pZi'
IHEREBY CERTIFY THATTHEINDIVIDUALWHOPRE P1a$EDTHE PLAN5NND SPECIFICATIONS HAS DONE
Cn IKI .ArrnDnA LIrr wlTW fGrTInm SCA 1 n❑ TWr. a K R%67A 1n DDndFcclrvn z.,rnnF nF THE- STATE
1 f FORM 284-208 (REV. 1-701 es ��