176913 (FSS)NO.
FIELD OFFICE
PLUMBING FEES
IJRAINAGE PIPING
DRINKING FOUNTAI
URINAL
WATER PIPING
FLOOR DRAIN
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD
MOTOR H. P.
DEPARTMENT OF BUILDING & SAFETY
0 COUNTY OF RIVERSIDE 0
WASHER (AUTO) (DISH)
CONSTRUCTION ESTIMATE
ELECTRICAL FEES
1st FI.
2nd FI.
Por.
Gar.
Car P.
Wall
GARBAGE DISPOSAL
Sq. Ft. @
OUTLETS
NO.
Sq. Ft. @
°
Sq. Ft. @
rN v>c W f
Sq. Ft. @
POLES
Sq. Ft. @
Sq. Ft. @
SIGHS
".o,Ra-L iN�'/"'�,-
Sq. Ft. @
MOTOR H. P.
RANGE AND/OR OVEN
MOTOR H.P.
ESTIMATED VALUATION Is
APPLIANCE VENT
MOTOR H. P.
MECHANICAL FEES
T e
NO.
FIELD OFFICE
PLUMBING FEES
IJRAINAGE PIPING
DRINKING FOUNTAI
URINAL
WATER PIPING
FLOOR DRAIN
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
ZONE
U F BUIVDI -
rK<
WATER CLOSET
COMPRESSOR OHP
RANGE AND/OR OVEN
LAVATORY
APPLIANCE VENT
WATER HEATER
SHOWER
ABSORPTION SYSTEM D B.T.U.
SPACE HEATER
F
BATH TUB
INCINERATOR DOMESTIC ❑ INDUS. ❑ COMM.
CONSTRUCTION POLE
MECHANICAL FEE $
WATER HEATER
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
SERVICE ENTRANCE
SEWAGE DISPOSAL
BOILER B.T.U.
RESID. to SO. FT.
HOUSE SEWER
PERMIT FEE
GARAGE iQ SO. FT.
I TYPE
GAS PIPING
PERMIT NUMBER -
PERMIT FEE
G
y PERMIT FEE
PERMIT NUMBER REN. DBL. TOTAL FEES.
HEAT IN VENT FEET PLN. CK. FEE CONST. FE ELEC, FEE PLUMB. FEE
J F _ M A M J J A- 5 _ O _ N D
J F M I A M _ J J A S O I N D
SET BACK
LOT SIZE
USE V
JOB ADDRESS OWNER
F
5
R'
ZONE
U F BUIVDI -
rK<
DATE
PLAN CHECK FEE $
i
j
CHECKy x-.1& `
OMMII IT
lj.
DI RICT
F
NI 5
VALUATION
OFF E'r
MECHANICAL FEE $
I /
F.ROUP
I TYPE
LEGA) L-DESi I N1 "
PERMIT NUMBER -
CONSTRUCTION FEE $
1, ( ;
176913
SPEC. INSP.
-
SUPP. TO PERMIT
�66
ELECTRICAL FEE $
PLAN CHECKER
BOND $
BOND
I CASH
PLAN FILE N
FINAL DATE
IN ECTOR
PLUMBING FEE $
I'��%
TOTAL FEES
$
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. o. N.C.
RECEIVED BY
SEWAGE SYSTEM
T
PERMIT WILL BE DONE IN ACCORDANCE WITH THE LAWS OF RIVER-
SIDE COUNTY AND THE STATE OF CALIFORNIA. I ALSO AGREE TO
T
LL
P
CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLI-
ANCE WITH LAWS OF THE STATE OF CALIFORNIA COVERING CON-
TRACTORS IS ALSO GUARANTEED.
NAME OF CONSTRUCTION
LENDER
OWNER
CONTRACTOR
BRANCH OFFICE
ADDRESS
ADDRESS
ADDRESS
CITY
TE
'- ��#" _�✓ '_G',� -� �: ,;�
NO LENDER INVOLVED
INFORMATION
TEL. NO.
TEL. -NO.
LICENSE NO.
•(,'jJ+t
284-208 12/6'8