221511 (BLCK)MOBILE HOME HOOKUP FEE '
E
VENT SYSTEM ❑ FAN. ❑EVAP. COOL ❑ HOOD
SIGN
BUILDING PERMIT
DEPARTMENT OF'BUILDING & SAFETY'
FIEMOFFICE
TRANS-. K.W.-
FORMER D
GARBAGE DISPOSAL"
Y
FURNACE ❑UNIT '❑WALL.❑FLOOR ❑SUSPENDED
COUNTY.OF RIVERSIDE.
LAUNDRY TRAY.
CONSTRUCTION, ESTIMATEr -,�: -• -• '' ELECTRICAL FEES •' •4w
•.'' PLUMBING FEES DST.,;
I ST FL. SQ. FT. @
NO..
NO.
2ND FL. SQ. FT. @
CONST. SERV. ENTRANCE
WATER CLOSET
POR. - SQ. FT. @
MOTOR I OR LESS H.P.
POLE
GAR. • SQ.FT. @
MOTOR 5 OR LESS H.P.
APPLIANCE VENT
CAR P. SQ. FT. Lai
MOTOR 20 OR LESS H.P.
DRAINAGE PIPING
,WALm,,-v,-,4 SQ.FT. Lai
T'
DRINKING FOUNTAIN •
SQ. FT. @
s
URINAL
ESTIMATED CONSTRUCTION VALUATION • .
$ 0 KW._ UNITS
WATER PIPING
NOTE: Not to be used as property rax'voluation
+,'
FLOOR DRAIN
MFrHAIJIC•AI FFFS:
VVATFD fr1FTFAIFD
MOBILE HOME HOOKUP FEE '
E
VENT SYSTEM ❑ FAN. ❑EVAP. COOL ❑ HOOD
SIGN
WASHER (AUTO) (DISH)
T. FEE
,APPLIANCE
TRANS-. K.W.-
FORMER D
GARBAGE DISPOSAL"
FEE I
FURNACE ❑UNIT '❑WALL.❑FLOOR ❑SUSPENDED
OUTLETS
LAUNDRY TRAY.
MECH. FEE
AIR HANDLING UNIT CFM
FIXTURE OR SOCKET
KITCHEN SINK
DBL
GAS PIPE O NATURAL ❑ L.P.G. O OIL
CONST. SERV. ENTRANCE
WATER CLOSET
COMPRESSOR 0 HP
POLE
LAVATORY
APPLIANCE VENT
AMPERES SERV. ENT.
SHOWER
--
ABSORPTION SYSTEM B.T.U.
SO. FT. @ Q
BATH TUB
PLAN NO.,
INCINERATOR O DOMESTIC ❑ INDUS. OR COMM. •
,- SQ. FT. @ Q
' WATER HEATER
JOBAD)RE55
_
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
SQ. FT. RES ID. @ 14
SEWAGE DISPOSAL
SUPP.
BOILER 0 B.T.U.
.-So. FT. GARAGE @a I�,4
HOUSE SEWER
75
PERMIT FEE -
BALANCE OF MIN. FEE
GAS PIPING
MOBILE HOME HOOKUP FEE '
E
is
-
PtRMII Ftt
T. FEE
I DBL.
SMI FEE
$
FEE I
PE M O
TOTAL FEES
MOB. HK. FEE MICRO FEE .
MECH. FEE
DBLi.
PL. CK'. FEE
CONST. FEE
DBL
OWNER
t-
PLAN CHECK FEE
•
$'�
DATE
PLAN NO.,
J. I -F I M
A I M I J I J
A I S' I �O -N I D
JOBAD)RE55
_
+'
73
74
SUPP.
-
U OFB IL ING'-
- -
75
M.H. HOOKUP FEE
NO LENDER INVOLVED
ELECTRICAL FEE
$
$
c MUNI V. .
• -
DST
UNITS
ROO
MICROFILM FEE
CITY •� - r
COPIES
$
14
#.
I , I
PERMIT FEE
-
T. FEE
I DBL.
SMI FEE
$
FEE I
PLUMB. FEE
DBL:
ONIr
SE NO. -
GRP
TYPE
B
OWNER
t-
PLAN CHECK FEE
•
$'�
DATE
PLAN NO.,
P RM1t 14
2
-
INSPECTOR
CONSTRUCTION FEE ;..
DBL
$
L•UATION
SUPP.
TO PERMIT
OFFICE
4.0
BRANCH OFFICE .• .
NO LENDER INVOLVED
ELECTRICAL FEE
L GAL D CR PTION
]�`
`CK
MECHANICAL FEE -
DBL
$
SET BACK •
`LOT S12E
ONIr
SE NO. -
GRP
TYPE
B
t-
PLAN CHECK FEE
•
$'�
BOND AMT.
PLAN NO.,
PLAN CHECKER
FINAL DATE -
INSPECTOR
CONSTRUCTION FEE ;..
DBL
$
'
NAME OF CONST. LENDER • -
BRANCH OFFICE .• .
NO LENDER INVOLVED
ELECTRICAL FEE
DBL
$
• -
ADDRESS"
CITY •� - r
STATE - r.
#.
SMI FEE
$
THIS'PERMIT SHALL,BECOME'VOID IF WORK IS NOT COMMENCED WITHIN 60 DAYS. CESSA- '-
TION OF WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID. '
FEE
$
I HEREBY, AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE'DONE IN AC -
CORDANCE WITWTHE'LAW$ OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO
AGREE TO CARRY COMPENSATION INSURANCE }UPON MY EMPLOYEES. COMPLIANCE WITH
PLUMBING -FEE'
DBL
$ .
THE LAWS OF THE STATE OF CALIFORNIA COVERING CONTRACTORS IS ALSO GUARANTEED.
I HEREBY CERTIFY THAT THE INDIVIDUAL.WHO PREPARED THE PLANS AND SPECIFICATIONS
$
TOTAL FEESHAS
_
DONE SO' IN ACCORDANCE. WITH SECTION 5541 OF THE BUSINESS AND,PP Q�SSIONS
CQDF OF THE STATE OF CALIFORNIA. �,-;. , ,
CASH CHECK O M.O. ❑ N.C. CIOWNER.
T
C rfRAGYOR J���"'✓ "
�` !• ���
RECEIVED BY �-
-.
ADDRESS Y
A DRESS
SEWAGE SYSTEM T-
LL
II_
TREES REQUIRED
YES
NO'
C".,. .,,
`
CITY
p/
- INFORMATION
OFORM 284-208 (Rev. 11/721
TEL. NO. -
�
TEL. NO. • LICENSE - -
-72 90 '. d �'y
7